No abstract

OBJECTIVE -To determine the effectiveness of specialist nurse-led clinics for hypertension and hyperlipidemia provided for diabetic patients receiving hospital-based care.RESEARCH DESIGN AND METHODS -This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure (Ն140/80 mmHg), raised total cholesterol (Ն5.0 mmol/l), or both. Individuals with diabetes were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for participants, with attendance every 4 -6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. Patients with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in hypertension and hyperlipidemia, attributable to the specialist nurse-led intervention.RESULTS -Overall, specialist nurse-led clinics were associated with a significant improvement in patients achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11-1.69], P ϭ 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P ϭ 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in patients enrolled in the specialist nurse-led clinic for hyperlipidemia , P ϭ 0.0007) than for hypertension , P ϭ 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality , P ϭ 0.02).CONCLUSIONS -This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of patients with diabetes. If the standards of care recommended in the National Service Framework for Diabetes are to be achieved, then such proven methods for delivering care must be adopted.

This study provides evidence that the use of specialist nurses to perform educational outreach to improve target adherence to patients with diabetes in primary care is not effective.

We studied the isometric contractile effects of increased PO₂ on isolated rings of lamb ductus arteriosus (from three different gestational age groups). When rings were stretched to initial lengths that result in a maximal contractile response for rings in that age group, the oxygen-induced contraction was 5.91 ± 0.72 g/mm² ( ± SEM, n = 18) in animals older than 135 days, 5.55 ± 1.23 g/mm² (n = 18) in animals between Ill and 130 days, and 3.85 ± 0.75 g/mm² (n = 19) in animals between 87 and 110 days. Only in the most immature vessels could a decrease in the tissue’s response to oxygen be observed.

No abstract