Treating diabetes mellitus in Prader-Willi syndrome with Exenatide.

We report the use of Exenatide, a GLP-1 agonist, in the management of diabetes mellitus in a 19 year-old female with Prader-Willi syndrome. The beneficial effects of Exenatide in weight reduction and appetite suppression provide a promising strategy for the treatment of obesity and diabetes mellitus in Prader-Willi syndrome.

A prospective case control study of the benefits of electronic discharge summaries.

A system of electronic discharge summaries was developed. It replaced conventional discharge prescriptions and dictated discharge summaries. We conducted a prospective case-control study of 102 consecutive patients admitted to our hospital under the care of one consultant physician. Patients discharged after 1 December 2004 were discharged using the new computerised system (50 patients) while patients admitted under the same medical team, but to another ward were discharged using the conventional paper discharge system (52 patients). Patients in the electronic group and the conventional group were similar in age (mean 67 years versus 58 years, P>0.05) and duration of hospital stay (6 days versus 1 day, P>0.05). The mean time taken to produce an electronic discharge summary was immediate (0 days) which was significantly (P<0.0001) less than the mean time taken to produce a conventional discharge summary (80 days). Combining electronic discharge prescriptions with electronic summaries appears promising and merits further study.

A comprehensive e-education engine for a virtual diabetes centre.

It seems likely that the development of effective diabetes education for patients, carers and staff would prove highly cost-effective. Diabetes-e is an electronic diabetes encyclopaedia designed to provide comprehensive education to patients, carers (e.g. family, schools, care homes) and health professionals (specialist and non-specialist). In addition, educational media such as information leaflets (that can be printed during a consultation), streaming educational video and slide resource packs are available. Self-assessment questionnaires with feedback guide further education and facilitate targeted continuing professional development (CPD) for health professionals. The prototype has been developed with a particular emphasis on patient input. It is anticipated that Diabetes-e will be implemented across Central Nottinghamshire, including training of key personnel, by the end of 2005. The project has already gone live for insulin commencement.

International educational partnerships for doctors in training: a collaborative framework with the RCP.

The UK offers excellent postgraduate medical education, and overseas doctors in training often covet a period of training in the UK. Some overseas training authorities make UK training mandatory prior to appointment as a consultant. Unfortunately, the organisation of such training often proves to be ad hoc, and may lack educational value. UK training faces challenges as a result of reduced hours of work, more structured and intensive educational needs, and pressures of increasing clinical demand. A plethora of new 'trust' posts have developed, often with limited educational value, creating a risk that training quality for overseas doctors is reduced. Against this background, such posts can be used to create international training partnerships such as that at Sherwood Forest Hospitals NHS Trust (SFHT), providing high-quality general and specialty training. Given the success of this strategy, it would be desirable for other UK trusts to provide similar schemes offering specialties not covered at SFHT.

Retrospective analysis of abnormal 24-h urinary free catecholamine concentration in screening for phaeochromocytoma.

BACKGROUND: Patients with hypertension often have increased 24-h excretion of urinary free catecholamines (UFCA) compared with normotensive patients, but the extent to which beta-blockade and other antihypertensive agents affect 24-h UFCA concentrations remains unclear. Consequently, many patients with slightly elevated 24-h UFCA concentrations are not adequately investigated for the presence of phaeochromocytoma. METHOD: We undertook a retrospective study on patients with at least one abnormal 24-h urinary collection of adrenaline (Adr), noradrenaline (NA) or dopamine (DA) between July 1997 and December 1999 to assess these issues. RESULTS: Of the 168 patients identified with raised 24-h UFCA concentrations, 106 with hospital notes were audited. Of the 46 patients whose values were more than twice the upper reference limit, 24 had their result confirmed with a repeat sample and only 10 underwent computed tomography or m-iodobenzylguanidine scanning. Two patients of these 10 had a phaeochromocytoma. We observed that hypertension correlated with significantly increased NA excretion compared with normotensive patients (median value 490+/-222 nmol per 24 h versus 304+/-229 nmol per 24 h, P<0.005). Patients on beta-blockers showed a trend towards significantly increased NA excretion (P=0.08). CONCLUSIONS: Many patients with abnormal 24-h UFCA excretion are not thoroughly investigated for the presence of phaeochromocytoma. NA concentration is significantly raised above the reference limit for patients with hypertension, and the use of beta-blockers showed a trend towards a further elevation in NA concentrations. Care must therefore be taken when interpreting abnormal NA concentrations in patients with hypertension or in those taking beta-blockers.