No abstract

Five years ago a new Young Persons' clinic was set up at the Royal Victoria Hospital, Belfast, to facilitate transfer from paediatric to adult services. Following establishment of the new clinic, this audit was carried out to ascertain attendance of those transferring to adult diabetic clinics, to identify reasons for non‐attendance, and to provide a basis for improving transfer. Outcome measures following transfer were HbA1c and number of failed appointments. Over a two‐year period 33 patients with type 1 diabetes mellitus transferred to the adult diabetic clinics at the Royal Victoria Hospital, and four transferred to other hospitals. Six of those patients supposed to transfer to the adult diabetic clinic at the Royal Victoria Hospital were not seen over the two‐year follow up. Only six patients attended all scheduled appointments. Following transfer, attendance was rated good in 36%, moderate in 33% and poor in 30%. Attendance did not appear to be related to control following transfer. There was an impression of better attendance at the Young Persons' clinic compared to those who transferred to the routine adult clinic. Whilst the new clinic can be considered successful, significant concerns remain about attendance around the time of transfer from paediatric to adult services. Copyright © 2006 John Wiley & Sons, Ltd.

Risk of type 1 diabetes at 3 years is high for initially multiple and single Ab+ IT and multiple Ab+ NT. Genetic predisposition, age, and male sex are significant risk factors for development of Ab+ in twins.

The effects of flosequinan and enalapril on exercise capacity (bicycle exercise duration), quality-of-life symptomatology (visual analogue scales) and New York Heart Association (NYHA) grading, were compared in 61 patients with chronic heart failure (NYHA, grade III). Bicycle exercise duration improved similarly with flosequinan (+27%) and enalapril (+18%); in patients completing the study, flosequinan produced a significantly greater increase in exercise time at week 12, compared with enalapril (P = 0.02). Improvements in visual analogue scores relating to general health, energy and vitality, ability to perform physical activities and breathing performance, were equivalent for both drugs. Changes in NYHA classification showed that 27 (55%) of 49 patients completing the study had improved by at least one NYHA grade (15 (68%) patients on flosequinan; 12 (44%) on enalapril). The overall safety and tolerability of the two treatments was similar; 18 patients reported adverse effects while on flosequinan, compared with 19 patients on enalapril. Neither treatment was associated with any clinically important changes in haematological or biochemical variables, although some treatment-related effects were observed. This study confirms that flosequinan achieved similar efficacy to enalapril in the symptomatic relief of chronic heart failure. The effect of flosequinan on survival in chronic heart failure has not been tested; pending such studies, our data suggest that it may prove a useful alternative therapy in patients where ACE inhibitors are contraindicated or poorly tolerated.