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REFERENCESVan Dieijen-Visser MP, Salemans T, Van Wersch J WJ, Schellekeus LA, Brombacher PJ. Glycosylated serum proteins and glycosylated haemoglobin in normal pregnancy. Ann Clin Biochem 1986; 23: Lloyd DR, Marples J. Glycosylated The relationship between serum cholesterol and serum thyrotropin in women with peripheral arterial disease Recently it has been suggested that, in subjects over 40 years old with suspected hypothyroidism, thyroid hormones control about 15% of the variability of serum cho1esterol.l Thyrotropin is the most reliable of the thyroid analytes2 and can therefore be used to assess the setting of thyroid gland activity in individuals. We have previously used thyrotropin levels to assess occult hypothyroidism in elderly women with intermittent c l a~d i c a t i o n .~ Amongst these patients we noted a significant correlation of thyrotropin (TSH) with cholesterol even when TSH was within the normal range, 0.2-4.0mU/L.3 We have extended these observations to over 200 postmenopausal women patients with symptomatic arterial disease. The serum cholesterol and TSH was measured in women attending the Charing Cross arterial clinic, over a period of 3 years, 1986-1989. The patients were all over 50 years old and had presented with symptomatic arterial disease in the aorto-distal circulation (claudication, rest pain or gangrene) or the carotid arteries (transient ischaemic attacks or stroke).Patients with known thyroid disease or heterozygous for familial hypercholesterolaemia (family history and LDL-receptor genotyping) were excluded from the study group as were patients with initial TSH > 4 rnU/L. The patients returned to clinic every 12 months for follow up of their arterial disease. At each annual visit a fasting blood sample was taken and the patient's height and weight measured. The mean age of the 202 patients studied, on entry, was 69 -t 8 years. An immunoradiometric assay was used to determine TSH, the coefficient of variation being 6.3% at a level of 1.2 mU/L and 28% at a level of 0.2 mU/L.The intraindividual coefficients of variation for cholesterol and TSH were calculated from estimates of precision between pairs of results. The intraindividual coefficient of variation was 9% for cholesterol and 18% for TSH. No patient had a weight change of > 5 % during the period of follow up. A positive correlation was observed between serum cholesterol and TSH, r=0.42, P

Medical Research Society 5,years) were identified from a random sample of i) discharge prescriptions which included digoxin therapy, or ii) clinical coding of atrial fibrillation on discharge, and confirmed from case notes. Only 44/82 (54%) patients were taking aspirin or warfarin; of the remainder 9 patients had contra-indications to both drugs leaving 29/82 (35%) patients without stroke prevention therapy at discharge. To improve prescribing, ward pharmacists on medical wards were asked to challenge prescriptions for digoxin seen without the co-prescription of warfarin or aspirin. In addition, a sticker was introduced which identified the patient on the prescription card as one who may benefit from anti-thrombotic medication. On re-audit in 1997, 84 patients (49% male, median age 77 years, range 48-91) had atrial fibrillation and 62 (74%) were taking aspirin or warfarin. Of the remainder, 6 patients had contraindications to stroke prevention therapy, leaving 16/84 (1 9%) patients which is significantly lower than before (Chi square4.8, p=0.029) despite the presence of stickers in only 4 sets of notes examined.This study shows that ward pharmacists can help to implement guidelines and improve evidence based practice.Gestational diabetes mellitus (GDM) and impaired glucose tolerance during pregnancy are associated with insulin resistance

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