Browsing Specialist Medicine by Title
Now showing items 414-415 of 415
A year in politics: An update on political influences on rheumatology and its traineesThe Health and Social Care Bill sets the triple challenge for the English NHS of the greatest changes in the history of the organization, at a rapid pace (in spite of the pause for the Futures Forum), and against the backdrop of having to save 20 billion by 2015. Furthermore, there is an expectation that the new NHS will have patients at the centre of the reforms, with commissioning driven by quality and outcomes, and that integration which will be achieved across primary and specialist care even though increasing commercialization will be encouraged. Rheumatologists cannot be complacent, because if they are not instrumental in assisting changes to their service to meet these challenges, then changes will inevitably be imposed on them, and in a fashion which may be unpalatable, and potentially decrease the quality of their service. We will present two viewpoints, first from Dr Alan Nye, GP, President Elect of the Primary Care Rheumatology Society and Director of Pennine MSK Partnership which provides community based rheumatology services in Oldham, and Dr Chris Deighton, consultant rheumatologist Royal Derby Hospital and President Elect of the BSR. At the time of writing, it is difficult to predict what the impact of these reforms will be in 6 months time, particularly with the world economy in crisis. These talks will give up-to-date overviews of * The reforms and impact on specialist musculoskeletal care generally and rheumatology particularly: * Examples of where this is working well * Examples of where there are still challenges * What the BSR is doing to influence the process and assist rheumatologists * Tactics for ensuring that integrated care is promoted * Tactics for ensuring that care is patient centred, and quality and outcomes driven * Tactics to demonstrate a specialist service is cost effective At the end of these talks it is hoped that all attendees will better appreciate the challenges that rheumatology faces, but be inspired by the opportunities, and the progress that colleagues have already made around the country.
Young adults with Type 1 diabetes: A retrospective observational single-centre studyAims: A retrospective review of clinical outcomes for young adults with Type 1 diabetes from the East Midlands was conducted in 2003. We aimed to explore whether glycaemic control in young adults had improved in 2016. In paediatric diabetes the Best Practice Tariff has been associated with a reduction in HbA1c. Methods: Patients aged 18-25 years with Type 1 diabetes attending Derby Teaching Hospitals were included. Data were collected retrospectively from case notes and computer records on glycaemic control, the prevalence of complications, clinic and structured education attendance. Results: A total of 127 patients were included in this analysis. Mean age of patients was similar between the 2016 and 2003 cohorts (20.9 +/- 2.6 vs 20.3 +/- 2.6 years) but duration of diabetes was less in 2016 (7.9 +/- 5.6 vs 10.0 +/- 5.6 years). Mean HbA1c levels were unchanged between the two cohorts at 80mmol/mol (9.5%) for both. Within the present cohort 4.3% and 12.8% achieved an HbA1c target of < 48mmol/mol (6.5%) and < 58mmol/ mol (7.5%) respectively. The majority used MDI therapy (85%, n = 108), followed by insulin pump therapy (9%, n = 11). Only 6% (n = 4) were on a twice daily mixed insulin. One fifth were DAFNE graduates (20.6%, n = 27). DNA rate was 31.3%. Of those screened, half had retinopathy (48%, n = 42). Conclusion: In contrast to the paediatric population and despite the use of intensified insulin therapy, insulin pumps and DAFNE, glycaemic control in young adults with Type 1 diabetes remains poor. Extension of the Best Practice Tariff to those < 25 years may benefit outcomes in this cohort.