The applications of Australian-coded ICD-10 and ICD-10-AM data in research: A scoping review of the literature.

Background: Australia uses the International Classification of Diseases (ICD-10) for mortality coding and its Australian Modification, ICD-10-AM, for morbidity coding. The ICD underpins surveillance (population health, mortality), health planning and research (clinical, epidemiological and others). ICD-10-AM also supports activity-based funding, thereby propelling realignment of the foci of clinical coding and, potentially, coded data's research utility. Objective: To conduct a scoping review of the literature exploring the use of ICD-10 and ICD-10-AM Australian-coded data in research. Research questions addressed herein: (1) What were the applications of ICD-10(-AM) Australian-coded data in published peer-reviewed research, 2012-2022? (2) What were the purposes of ICD-10(-AM) coded data within this context, as classified per a taxonomy of data use framework? Method: Following systematic Medline, Scopus and Cumulative Index to Nursing and Allied Health Literature database searches, a scoping literature review was conducted using PRISMA Extension for Scoping Reviews guidelines. References of a random 5% sample of within-scope articles were searched manually. Results were summarised using descriptive analyses. Results: Multi-stage screening of 2103 imported articles produced 636, including 25 from the references, for extraction and analysis; 54% were published 2019-2022; 50% within the largest five categories were published post-2019; 22% fell within the "Mental health and behavioural" category; 60.3% relied upon an ICD-10 modification. Articles were grouped by: research foci; relevant ICD chapter; themes per the taxonomy; purposes of the coded data. Observational study designs predominated: descriptive (50.6%) and cohort (34.6%). Conclusion: Researchers' use of coded data is extensive, robust and growing. Increasing demand is foreshadowed for ICD-10(-AM) coded data, and HIM-Coders' and Clinical Coders' expert advice to medical researchers.

Workforce survey of Australian health information management graduates, 2017-2021: A 5-year follow-on study.

Background: Employment outcomes of La Trobe University's 2012-2016 health information manager (HIM) graduate cohort were reported previously. Objectives: To identify the 2017-2021 Australia-based, graduate HIMs' early career employment experiences; identify employment roles and destinations; investigate knowledge and skill sets utilised in professional performance; and compare outcomes with the previous study. Method: A cross-sectional design was utilised. An online survey elicited: demographic data, position-related details and knowledge-skills applied in the workplace. Inter- and intra-cohort comparisons were calculated. Results: Of contactable graduates, 75% (n = 150) completed the survey; 90% (n = 132) had held at least one profession-related position postgraduation; 51% gained employment before final examinations and 92% within 6 months. In their first role, 87% joined the public healthcare sector, 47% had worked in two or more positions and 12.3% in three or more positions. Categorisation of position titles showed that 40% had undertaken "health information management" roles, 14.9% "health classification," 16.6% "data management and analytics," 17.4% "health ICT" and 11.1% "other," roles. Almost two-thirds (64.1%) had utilised three or four of the four professional knowledge-skill domains. There was an increase, from the 2012 to 2016 cohort, in those undertaking "data management and analytics" and "health ICT" roles, and a decrease in "health classification" role uptake. Conclusion: Early-career HIMs have very high employability. They engage throughout health care, predominately in the public health sector. Their mobility reflects national workforce trends. The majority utilise all or most of the professional knowledge-skill domains studied at university.

Intra-articular versus intravenous administration of tranexamic acid in lower limb total arthroplasty: a systematic review and meta-analysis of randomised clinical trials.

AIM: The ideal route of tranexamic acid (TXA) administration in total hip arthroplasty (THA) or total knee arthroplasty (TKA) remains controversial. This study aims to identify the optima route of TXA administration in THA or TKA. METHODS: PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched until 4 August 2021 for randomised studies that compared intravenous (IV) or intra-articular (IA) administration of TXA in THA or TKA. RESULTS: Sixty-seven studies enrolling 8335 patients (IA: 4162; IV: 4173) were eligible for quantitative and qualitative analysis. Comparable results were demonstrated in the incidence of venous thromboembolisation (OR:0.96, p = 0.84), total blood loss (MD: - 9.05, p = 0.36), drain output (MD: - 7.36, p = 0.54), hidden blood loss (MD: - 6.85, p = 0.47), postoperative haemoglobin level (MD: 0.01, p = 0.91), haemoglobin drop (MD: - 0.10, p = 0.22), blood transfusion rate (OR: 0.99, p = 0.87), total adverse events (OR: 1.12, p = 0.28), postoperative range of motion (MD: 1.08, p = 0.36), postoperative VAS pain score (MD: 0.13, p = 0.24) and postoperative D-dimer level (MD: 0.61, p = 0.64). IV route of TXA administration was associated with significantly longer length of hospital stay compared to IA route of administration (MD: - 0.22, p = 0.01). CONCLUSION: In this meta-analysis, both IV and IA route of TXA administration were equally effective in managing blood loss and postoperative outcomes in lower limb joints arthroplasty. LEVEL OF EVIDENCE: Level 1. PROSPERO Registration CRD42021271355.

Presence of Delocalized Ti 3d Electrons in Ultrathin Single-Crystal SrTiO3.

Strontium titanate (STO), with a wide spectrum of emergent properties such as ferroelectricity and superconductivity, has received significant attention in the community of strongly correlated materials. In the strain-free STO film grown on the SrRuO3 buffer layer, the existing polar nanoregions can facilitate room-temperature ferroelectricity when the STO film thickness approaches 10 nm. Here we show that around this thickness scale, the freestanding STO films without the influence of a substrate show the tetragonal structure at room temperature, contrasting with the cubic structure seen in bulk form. The spectroscopic measurements reveal the modified Ti-O orbital hybridization that causes the Ti ion to deviate from its nominal 4+ valency (3d0 configuration) with excess delocalized 3d electrons. Additionally, the Ti ion in TiO6 octahedron exhibits an off-center displacement. The inherent symmetry lowering in ultrathin freestanding films offers an alternative way to achieve tunable electronic structures that are of paramount importance for future technological applications.

Disruptive Technology, Leadership and the Future of Nursing.

Nurses need to take a strategic leadership role in managing disruptive health technologies that can be adopted to improve health and care within the population. While innovative technology developments continue to advance quickly, systematic changes to the health and care systems are not always geared to take advantage of these advances at the same rate. This panel will look at how disruptive technology will impact nursing practice and strategic leadership factors that shape acceptance/resistance to new technologies.

Spectroscopic characterization of electronic structures of ultra-thin single crystal La0.7Sr0.3MnO3.

We have successfully fabricated high quality single crystalline La0.7Sr0.3MnO3 (LSMO) film in the freestanding form that can be transferred onto silicon wafer and copper mesh support. Using soft x-ray absorption (XAS) and resonant inelastic x-ray scattering (RIXS) spectroscopy in transmission and reflection geometries, we demonstrate that the x-ray emission from Mn 3s-2p core-to-core transition (3sPFY) seen in the RIXS maps can represent the bulk-like absorption signal with minimal self-absorption effect around the Mn L3-edge. Similar measurements were also performed on a reference LSMO film grown on the SrTiO3 substrate and the agreement between measurements substantiates the claim that the bulk electronic structures can be preserved even after the freestanding treatment process. The 3sPFY spectrum obtained from analyzing the RIXS maps offers a powerful way to probe the bulk electronic structures in thin films and heterostructures when recording the XAS spectra in the transmission mode is not available.

Upgrade of the SPECIES beamline at the MAX IV Laboratory.

The SPECIES beamline has been transferred to the new 1.5 GeV storage ring at the MAX IV Laboratory. Several improvements have been made to the beamline and its endstations during the transfer. Together the Ambient Pressure X-ray Photoelectron Spectroscopy and Resonant Inelastic X-ray Scattering endstations are capable of conducting photoelectron spectroscopy in elevated pressure regimes with enhanced time-resolution and flux and X-ray scattering experiments with improved resolution and flux. Both endstations offer a unique capability for experiments at low photon energies in the vacuum ultraviolet and soft X-ray range. In this paper, the upgrades on the endstations and current performance of the beamline are reported.

Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review.

INTRODUCTION AND AIMS: Esmolol is an ultra-short-acting ß1 antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of which is torsades de pointes . The aim of this systematic review was to compare esmolol and placebo on QTc changes occurring during LTI. MATERIALS AND METHODS: PubMed, EMBASE, Cochrane Registry of Clinical Trials and CINAHL databases (up to August 2018) were screened for randomised controlled trials comparing esmolol and placebo on QTc changes during LTI in cardiac and non-cardiac surgeries. The primary outcome was QTc changes during LTI and secondary outcome was related to adverse effects from esmolol such as bradycardia and hypotension. RESULTS: Seven trials were identified involving 320 patients, 160 patients receiving esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in the esmolol group compared with the placebo in four studies. Compared with the baseline, the QTc was reduced post-LTI in the esmolol group. In the placebo group, the QTc was prolonged compared with the baseline post LTI. Nonetheless, esmolol did not prevent QTc prolongation in the remaining three studies, and much of this was attributed to employing QTc prolonging agents for premedication and anaesthetic induction. No significant adverse events were noted. CONCLUSION: Compared with placebo, esmolol reduced the LTI-induced QTc prolongation when current non-QTc prolonging agents were chosen for tracheal intubation. Future studies should explore whether transmural dispersion (a marker of torsadogenicity) is also affected during LTI by analysing parameters such as the Tp-e interval (interval between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected Tp-e interval). TRIAL REGISTRATION NUMBER: CRD42018090282.

The fluctuating population of Sm 4f configurations in topological Kondo insulator SmB6 explored with high-resolution X-ray absorption and emission spectra.

High-resolution partial-fluorescence-yield X-ray absorption and resonant X-ray emission spectra were used to characterize the temperature dependence of Sm 4f configurations and orbital/charge degree of freedom in SmB6. The variation of Sm 4f configurations responds well to the formed Kondo gap, below 140 K, and an in-gap state, below 40 K. The topological in-gap state is correlated with the fluctuating population of Sm 4f configurations that arises via carrier transfer between 3d94f6 and 3d94f5 states; both states are partially delocalized, and the mediating 5d orbital plays the role of a transfer path. Complementary results shown in this work thus manifest the importance of configuration fluctuations and orbital delocalization in the topological surface state of SmB6.

Relation between the Co-O bond lengths and the spin state of Co in layered Cobaltates: a high-pressure study.

The pressure-response of the Co-O bond lengths and the spin state of Co ions in a hybrid 3d-5d solid-state oxide Sr2Co0.5Ir0.5O4 with a layered K2NiF4-type structure was studied by using hard X-ray absorption and emission spectroscopies. The Co-K and the Ir-L 3 X-ray absorption spectra demonstrate that the Ir5+ and the Co3+ valence states at ambient conditions are not affected by pressure. The Co Kß emission spectra, on the other hand, revealed a gradual spin state transition of Co3+ ions from a high-spin (S = 2) state at ambient pressure to a complete low-spin state (S = 0) at 40 GPa without crossing the intermediate spin state (S = 1). This can be well understood from our calculated phase diagram in which we consider the energies of the low spin, intermediate spin and high spin states of Co3+ ions as a function of the anisotropic distortion of the octahedral local coordination in the layered oxide. We infer that a short in-plane Co-O bond length (<1.90 Å) as well as a very large ratio of Co-Oapex/Co-Oin-plane is needed to stabilize the IS Co3+, a situation which is rarely met in reality.

Classification system for lateral pharyngotomy: systematic study of anatomic exposure in a human cadaver model.

INTRODUCTION: Lateral pharyngotomy (LP) is a surgical procedure that allows exposure to tumors of the pharynx and supraglottic larynx. This study was undertaken to: (1) propose a classification system of LP used in exposing various sites of the oropharynx, supraglottis, and hypopharynx. (2) Describe the structures visible with each category of LP. MATERIALS AND METHODS: Five tissue-fixed human cadavers from our gross anatomy laboratory were dissected in a manner similar to surgical lateral pharyngotomy. After exposure of the neurovascular structures of the anterior compartment of the neck and laryngeal framework, traditional pharyngotomy was performed with entry between the hypoglossal nerve cephalically and the superior laryngeal nerve caudally (traditional LP). Progressively increased exposure was created by division of adjacent structures. The ability to visualize certain structures (epiglottis, ipsilateral and contralateral base of tongue, postcricoid area, arytenoids, uvula, soft palate, and vallecula) through the pharyngotomy was recorded. RESULTS: The epiglottis and ipsilateral tongue base were visible via the traditional or Type I LP. Type II, III, and IV LP provided exposure to increasingly remote sites of the pharynx and supraglottic larynx. The additional exposure provided by each type of LP was consistent across all five cadaver specimens. CONCLUSION: Our system catalogs the additional exposure of both cephalic and caudal tumor sites associated with division of adjacent structures. This anatomic study illustrates and systematizes the structures requiring division to provide access to a given tumor location.

Influence of Fe substitution on the Jahn-Teller distortion and orbital anisotropy in orthorhombic Y(Mn1-xFex)O3 epitaxial films.

Multiferroic YMn1-xFexO3(020) (x = 0.125, 0.25, 0.50) epitaxial thin films with an orthorhombic structure (space group Pbnm) were prepared on a YAlO3(010) substrate by pulsed-laser deposition. Upon Fe substitution, the b-axis was clearly shortened, whereas the a- and c-axes were slightly lengthened based on XRD analysis. To understand the influence of orbital polarization and the Jahn-Teller effect of Mn(3+) on Fe substitution and also the local octahedral-site distortion of Fe(3+) in an environment of Jahn-Teller-active Mn(3+) ions in YMn1-xFexO3 films, we measured the polarization-dependent X-ray absorption spectra at the Mn-L2,3 and Fe-L2,3 edges, and also simulated the experimental spectra using configuration-interaction multiplet calculations. Although Δeg for the Mn(3+) ion decreased from 0.9 eV in pure YMnO3 to 0.6 eV in the half-Fe-substituted sample, a single eg electron was still strongly constrained to the d3y(2)-r(2) orbital for all the Fe concentrations tested. The largest Δeg, 0.5 eV, for the Fe(3+) ion was derived for a sample with 12.5% Fe substitution, and gradually decreased to 0.15 eV for the half-Fe-substituted sample. The local octahedral-site distortion of the Fe(3+) ion inside the YMnO3 lattice was similar to that of the Mn(3+) ion, whereas the Jahn-Teller distortion and GdFeO3-type distortion of the Mn(3+) ion were decreased by the spherical high-spin Fe(3+) ions. The combination of the experimental and theoretical data provides both profound insight into the variation of the Jahn-Teller distortion and orbital anisotropy and instructive information about the magnetic structures in these orthorhombic YMn1-xFexO3 thin films.

Low temperature structural anomalies arising from competing exchange interactions in pyrochlore Nd2Ru2O7 probed by XRD and EXAFS.

Quantitative structural parameters of pyrochlore Nd2Ru2O7, with temperature dependence, have been derived upon fitting XRD and EXAFS data. An anomalous expansion of the lattice parameter and the Ru-O bond length indicates a structural instability at low temperatures; in particular, an increase in the non-thermal term of the mean square fluctuation in the bond length is the evidence for a static disorder of Ru atoms. This static disorder is closely correlated with a decrease in the average Ru-O-Ru bond angle with decreasing temperature, favoring the short-range ferromagnetic coupling in the material. This ferromagnetic coupling formed thus triggered the spin frustration at low temperature when the contradictory constraints of antiferromagnetic interaction act upon the same Ru site in the corner-sharing tetrahedrons of pyrochlore Nd2Ru2O7. This study demonstrates that the spin frustration arising from the competition of ferromagnetic/antiferromagnetic interactions in pyrochlore Nd2Ru2O7 will cause structural instability especially on the atomic scale, which provides a new point of view to help understand its particular magnetic state.

Effect of sertraline on Ca²âº fluxes in rabbit corneal epithelial cells.

The effect of sertraline, a selective serotonin reuptake inhibitor (SSRI), on cytosolic free Ca²âº concentrations ([Ca²âº](i)) in a rabbit corneal epithelial cell line (SIRC) is unclear. This study explored whether sertraline changed basal [Ca²âº](i) levels in suspended SIRC cells by using fura-2 as a Ca²âº-sensitive fluorescent dye. Sertraline at concentrations between 10-100 µM increased [Ca²âº](i) in a concentration-dependent manner. The Ca²âº signal was reduced by 23% by removing extracellular Ca²âº. Sertraline induced Mn²âº influx, leading to quench of fura-2 fluorescence, suggesting Ca²âº influx. This Ca²âº influx was inhibited by phospholipase A2 inhibitor aristolochic acid, but not by store-operated Ca²âº channel blockers and protein kinase C/A modulators. In Ca²âº-free medium, pretreatment with the endoplasmic reticulum Ca²âº pump inhibitor thapsigargin, cyclopiazonic acid or 2,5-di-tert-butylhydroquinone greatly inhibited sertraline-induced Ca²âº release. Inhibition of phospholipase C with U73122 abolished sertraline-induced [Ca²âº](i) rise. At concentrations of 5-50 µM, sertraline killed cells in a concentration-dependent manner. The cytotoxic effect of 25 µM sertraline was not reversed by prechelating cytosolic Ca²âº with BAPTA/AM. Collectively, in SIRC cells, sertraline induced [Ca²âº](i) rises by causing phospholipase C-dependent Ca²âº release from the endoplasmic reticulum and Ca²âº influx via phospholipase A2-sensitive Ca²âº channels. Sertraline-caused cytotoxicity was mediated by Ca²âº-independent pathways.

A complete high-to-low spin state transition of trivalent cobalt ion in octahedral symmetry in SrCo0.5Ru0.5O(3-δ).

The complex metal oxide SrCo0.5Ru0.5O(3-δ) possesses a slightly distorted perovskite crystal structure. Its insulating nature infers a well-defined charge distribution, and the six-fold coordinated transition metals have the oxidation states +5 for ruthenium and +3 for cobalt as observed by X-ray spectroscopy. We have discovered that Co(3+) ion is purely high-spin at room temperature, which is unique for a Co(3+) in an octahedral oxygen surrounding. We attribute this to the crystal field interaction being weaker than the Hund's-rule exchange due to a relatively large mean Co-O distances of 1.98(2) Å, as obtained by EXAFS and X-ray diffraction experiments. A gradual high-to-low spin state transition is completed by applying high hydrostatic pressure of up to 40 GPa. Across this spin state transition, the Co Kß emission spectra can be fully explained by a weighted sum of the high-spin and low-spin spectra. Thereby is the much debated intermediate spin state of Co(3+) absent in this material. These results allow us to draw an energy diagram depicting relative stabilities of the high-, intermediate-, and low-spin states as functions of the metal-oxygen bond length for a Co(3+) ion in an octahedral coordination.

Elevated serum retinol-binding protein 4 concentrations are associated with chronic kidney disease but not with the higher carotid intima-media thickness in type 2 diabetic subjects.

To examine the association of serum retinol-binding protein 4 (RBP4) concentrations with carotid intima-media thickness (CIMT) in type 2 diabetic subjects with chronic kidney disease (CKD). A total of 239 type 2 diabetic patients (64 ± 13 years, 154 males) were divided into two groups: one with CKD, defined as estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73m(2) (n = 86), and one without (n = 153). We recorded clinical and biochemical data as well as CIMT. The patients with CKD were older, had had diabetes mellitus longer, and had higher incidence of hypertension, dyslipidemia and microalbuminuria than those without. They also had higher serum concentrations of RBP4 (44.8 ± 6.4 vs 39.5 ± 4.9 µg/mL, p < 0.001), higher mean CIMT (0.75 ± 0.16 vs 0.69 ± 0.14 mm, p = 0.0070), and higher incidence of carotid plaques (27.9 vs 11.8 %, p = 0.002). The RBP4 were negatively correlated with eGFR (r = -0.514, p < 0.001). However, the RBP4 were not correlated with mean CIMT (r = 0.065, p = 0.318). Moreover, when dividing the patients into two groups by the mean CIMT, those with mean CIMT above 0.71 mm did not have different RBP4 concentrations compared with those below (41.5 ± 5.7 vs 41.3 ± 6.3 µg/mL, p = 0.856). In conclusion, we observed an elevation of serum RBP4 concentrations and CIMT levels in type 2 diabetic subjects with CKD. However, the elevated RBP4 were not associated with the higher CIMT among these patients.

Hyperthyroidism-associated insulin resistance is not mediated by adiponectin levels.

To evaluate the relationship between circulating adiponectin and insulin sensitivity in patients with hyperthyroid Graves' disease, we studied 19 adult patients with this disease and 19 age- and sex-matched euthyroid controls. All hyperthyroid patients were treated with antithyroid drugs and were re-evaluated after thyroid function normalized. Before antithyroid treatment, the adiponectin plasma concentrations were not different comparing with those in control group. The adiponectin levels remained unchanged after treatment. The homeostasis model assessment of insulin resistance (HOMA-IR) in hyperthyroid group was higher before treatment than after treatment. There was no significant difference in serum glucose and insulin levels between hyperthyroid and control groups and in the hyperthyroid group before and after treatment. BMI-adjusted adiponectin levels were not different among three groups. On the other hand, BMI-adjusted insulin levels and HOMA-IR values were significantly decreased after management of hyperthyroidism. Pearson's correlation revealed that insulin and HOMA-IR values positively correlated with triiodothyronine (T3) and free thyroxine (FT4) levels. However, adiponectin did not correlate with T3, FT4, insulin, HOMA-IR and thyrotropin receptor autoantibody (TRAb) levels. In conclusion, insulin resistance associated with hyperthyroidism is not mediated by the levels of plasma adiponectin.

Justifying the high prevalence of microalbuminuria for type 2 diabetic patients in Taiwan with conditional probability approach--a DEMAND II study.

BACKGROUND: To examine the prevalence of microalbuminuria (MAU) and chronic kidney disease as well as the correlation between MAU and renal and cardiovascular risks of Type 2 diabetes mellitus (T2DM) patients for public health policy making in Taiwan. METHODS: This was a multicenter, hospital-based, randomly selected, and cross-sectional study. T2DM patients aged 18-80 years without a known diagnosis of proteinuria were eligible. MAU was defined as urinary albumin-to-creatinine ratio (ACR) within 30-299 mg/g, and macroalbuminuria as that greater than or equal to 300 mg/g. Two positive out of three urinary screening results were required to make the diagnosis of MAU. The adjusted prevalence of MAU was calculated by conditional probability approach. RESULTS: 51.1% of the analyzed population (n=1,827) were women, with a mean (standard deviation) age of 59.16 years (11.19 years) and mean hemoglobin A1c (HbA1c) of 8.15% (1.83%). Median duration of DM history was 6 years (interquartile range, 3-11 years). The adjusted prevalence of MAU was 26.9%. Overall prevalence of chronic kidney disease Stage 3 or higher (estimated Glomerular filtration rate (eGFR) less than 60/mL/min/1.73 m²) was 13.8%. Only 4.7% of the T2DM patients had serum albumin test recorded and 68.7% with serum creatinine test recorded within the last 6 months. After adjustment for center and gender, the odds ratios for MAU or macroalbuminuria were 1.73 (95% CI, 1.27-2.36) for age greater than or equal to 60 years, 1.54 (1.13-2.10) for abnormal waist circumference, 1.10 (1.02-1.19) for every 1% increase in hemoglobin A1c, 1.91 (1.38-2.65) for higher systolic blood pressure, and 1.92 (1.19-3.07) for abnormal serum creatinine level. CONCLUSION: This study demonstrates the application of "conditional probability" method to justify the rationale of adopting two positive out of three urinary screening tests for the diagnosis of MAU. An adjusted prevalence rate of MAU as 26.9% is reported. These results may provide a basis for cost-benefit consideration in designing preventive and interventional policies in public health. Furthermore, the awareness and practice of early monitoring of MAU for DM patients should be strengthened.

Common hemoglobin variants in southern Taiwan and their effect on the determination of HbA1c by ion-exchange high-performance liquid chromatography.

BACKGROUND: Patients with hemoglobin (Hb) variants may produce false HbA1c measurement. This study aimed to detect the common Hb variants in southern Taiwan and to evaluate their effect on the determination of HbA1c. METHODS: A total of 1,434 samples collected for HbA1c measurement at Kaohsiung Veterans General Hospital in southern Taiwan in March 2008 were submitted for Hb variant analysis by Primus CLC-385. HbA1c measurements were obtained using ion-exchange high-performance liquid chromatography (HPLC) (Tosoh HLC-723 G7) for routine analysis. Patients identified with Hb variants were recalled for boronate-affinity HPLC analysis. The values of estimated average glucose (eAG) were converted from HbA1c. Values of eAG-FPG, calculated by eAG minus fasting plasma glucose (FPG), were compared to estimate the accuracy of HbA1c measurement in patients with Hb variants. RESULTS: Among the 1,434 patients, the mean standard deviation of FPG was 162.8 +/- 60.5 mg/dL, HbA1c was 8.28 +/- 1.97%, and eAG was 190.9 +/- 56.6 mg/dL. Five Hb variants were detected in 11 patients, the incidence being 0.76%. Hb J was identified in 4 patients, Hb G in 2 patients, Hb E in 1 patient, Hb owari in 3 patients, and high fetal hemoglobin (HbF) in 1 patient. Abnormal HPLC chromatograms were seen among the patients with Hb J, E, G and HbF, but not in the patients with Hb owari. In patients with Hb variants, FPG was 149.5 +/- 39.9 mg/dL, HbA1c was 7.29 +/- 2.01%, and eAG was 162.5 +/- 57.7 mg/dL. Lower values of eAG-FPG may have occurred in the patients with Hb J and E, and in those with high HbF. On scattergrams of the relationship between HbA1c and FPG, the plots of Hb J, E and high HbF lay below the regression line of non-Hb variants. Inconsistent Hb values between both methods were only observed among some samples of patients with Hb variants. CONCLUSION: The existence of Hb variants may result in false HbA1c measurement. The possible presence of spuriously low HbA1c levels or abnormal HPLC chromatograms by using ion-exchange methods should be kept in mind.

Patterns and their correlates of seeking treatment for erectile dysfunction in type 2 diabetic patients.

INTRODUCTION: Diabetic patients are at high risk of having erectile dysfunction (ED), but their doctors rarely pay attention to this association. AIM: To evaluate the treatment-seeking patterns and their correlates for ED in type 2 diabetic patients. METHODS: A questionnaire containing Sexual Health Inventory for Men and questions inquiring treatment-seeking patterns was mailed or given to 4,040 subjects who had visited our endocrinology outpatient department for diabetes during January 2004 to May 2006. MAIN OUTCOME MEASURES: The prevalence of being bothered and having interest in treatment, and the percentage having sought treatment in regard to ED and their correlates with age and ED severity. RESULTS: Of the subjects with questionnaire completed, 83.9% (708/844) had ED. Among the subjects with different severity of ED, the moderate group had the highest percentages regarding prevalence of being bothered (89.4%), having interest in treatment (78.5%), and having sought treatment (46.2%). Of all the subjects, only 14.2% had ever visited Western physicians, whereas embarrassment and misinformation about ED treatment were the leading reasons for never doing so. Over half (56.6%) of those with ED wished to discuss ED problem with their doctors, and of them 90.4% wished the doctors to initiate to broach this issue. CONCLUSIONS: The prevalence of ED and the concerns about it were high in these diabetic patients. ED severity was the major determinant of their treatment-seeking decision, whereas only few of them had ever sought professional help. Routine screening of ED in diabetic patients is recommended.