The aims of this study were to determine whether the introduction of a diabetes management e‐module can increase junior doctors' confidence in managing inpatients with diabetes and contribute to improvements in patient care.A diabetes e‐module was introduced at Barnet and Chase Farm Hospitals NHS Trust in October 2010. Junior doctors completed it and undertook an online exam at the end. Junior doctors were surveyed once, six to eight months after completing the e‐module, and retrospectively ranked their confidence and knowledge levels in managing inpatients with diabetes before and after completing the e‐module. Patient care was assessed by comparing the National Diabetes Inpatient Audit (NaDIA) findings at Barnet Hospital before and at two time points after the introduction of the e‐module.After undertaking the e‐module there were statistically significant increases in the self‐ranked confidence and knowledge levels of junior doctors regarding diabetes management. This included improvements in identifying different types of insulin, making insulin dose adjustments for hypoglycaemia/hyperglycaemia and a reduction in reported prescription errors. The results from the NaDIA also suggest an improvement in ‘good diabetes days’ for insulin‐treated patients with diabetes and a pattern of reduction in prescription and management errors.This study demonstrates that an inpatient diabetes management e‐module increases junior doctors' knowledge and confidence in managing diabetes. A multi‐centre study would be needed to confirm whether this translates into better management of inpatients with diabetes. E‐modules may be used to cover further topics in diabetes, and to support nursing and patient education. Copyright © 2013 John Wiley & Sons. Practical Diabetes 2013; 30(3): 122–127

A quantitative comparison has been performed between two commercial near-infrared (NIR) vein-viewing systems which are designed to supplement the clinician's traditional skills in locating veins by means of visualization and palpation. The AccuVein AV300 and Novarix IV-eye real-time imaging systems employ very different imaging geometries; the former generates an image from reflected NIR light produced by a beam scanned across the surface, while the latter illuminates the viewed region at four points on the periphery and records the resulting distribution of diffusely transmitted light. The comparison involved measuring the contrast produced by absorbing rods (simulated blood vessels) in a cylindrical phantom with tissue-like optical properties, and the contrast of superficial blood vessels in the arms of healthy volunteers. The locations and sizes of the blood vessels were independently verified using a clinical ultrasound imaging system. The phantom measurements suggested that the AV300 displays the most superficial vessels with greater contrast, but the IV-eye is able to detect vessels when they are at a depth up to 2 mm greater than the limit observed for the AV300. The results for thirty healthy volunteers also indicated that the AV300 typically displays vessels with higher overall contrast, but the effectiveness of the IV-eye at visualizing deeper vessels was even more pronounced, with a maximum depth several millimeters greater than that achieved by the AV300, and more than ten times as many vessels observed at depths below 4 mm.

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated phenomenon characterized by demyelination of the central nervous system that displays numerous manifestations. It predominantly presents in children with a mean age range of five to eight years. ADEM remains a diagnosis of exclusion based on clinical and radiographic progression. Thus, it poses a diagnostic challenge. ADEM has been shown to be very responsive to steroids and exchange therapy.Here, we present an unusual case of ADEM in a 50-year-old female patient who, despite receiving an entire course of IV methylprednisolone and other conventional treatment methods, did not respond to the treatment.