Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Proteins can be chemically modified by sugars by glycation, or the Maillard reaction. The Maillard reaction produces irreversible adducts on proteins that are collectively known as advanced glycation end products, or AGEs. Recent studies indicate that several alpha-dicarbonyl compounds, including glyoxal (GXL), are precursors of AGEs in vivo. We developed antibodies against a GXL-modified protein (GXL-AGE) and purified a mixture of GXL-AGE-specific antibodies by chromatography on GXL-modified bovine serum albumin (BSA-GXL) coupled to EAH-Sepharose. This preparation was then processed on a human serum albumin-carboxymethyllysine (HSA-CML)-NHS-Sepharose to remove CML-specific antibodies. We used the resulting purified antibody in a competitive ELISA to probe GXL-AGEs in vitro and in vivo. We found increasingly greater antibody binding with increasing concentrations of GXL-modified BSA, but the antibody failed to react with either free CML or protein-bound CML. Incubation experiments with BSA revealed that glyceraldehyde, ribose and threose could be precursors of GXL-AGEs as well. Experiments in which GXL was incubated with N-alpha-acetyl amino acids showed that the antibody reacts mostly with lysine modifications. The GXL-derived lysine-lysine crosslinking structure, GOLD was found to be one of the antigenic epitopes for the antibody. Analysis of human plasma proteins revealed significantly higher levels of GXL-AGE antigens in type II diabetic subjects compared with normal controls (P<0.0001). We also found GXL-AGEs in human lens proteins. Bovine aortic endothelial cells cultured for 7 days with 30 mM glucose did not accumulate intracellular GXL-AGEs. These studies underscore the importance of GXL for extracellular AGE formation (except in lens where it is likely to be formed intracellularly) and suggest that changes associated with age and diabetes might be prevented by alteration of GXL-AGE formation.
 ...
PMID:Maillard reactions by alpha-oxoaldehydes: detection of glyoxal-modified proteins. 1101 16

BACKGROUND: 'Measures' is a 2-year, part-funded European Community project. It began in March 1998 and has, as its primary foci, the aims of continuing to improve the quality and efficiency of patient care by, (1) re-examining healthcare processes and (2) determining how best to take advantage of information technology. Central to this has been patient involvement in the project. Initially the project is focused on aspects of rheumatology, diabetes and spinal injury services based across Pinderfields and Pontefract NHS Hospitals Trust. APPROACH: Patient questionnaires, interactive cross-specialty and individual specialty focus groups have been employed. The re-enforcement of relationships with voluntary organizations has featured prominently. CONCLUSION: Initial perception from patients participating in the process is highly positive and supportive. Specific areas to be considered for change have been addressed.
 ...
PMID:Patient participation in service improvement: the initial Measures Project experience. 1128 4

This paper describes a collaborative project: the Medway Integrated Care Support (MEDICS) Project, involving GP and Hospital system suppliers, an NHS Trust, General Practitioners and the NHS Information Authority. The objective of the project is to assess the Object Management Group's (OMG/CORBAMed) Clinical Observations Access Service (COAS) standard, by demonstrating its use in implementing a real-time interface between a GP system and a hospital clinical system, supporting the shared care of diabetes patient.
 ...
PMID:Implementing real-time system interfaces to support the shared care of diabetes patients. 1160 7

Diabetes information systems have already evolved rapidly in recent years along a developmental pathway initiated by the St Vincent Declaration, fuelled by the rapid pace of IT development in the 1990s and now endorsed by the emerging NHS information strategy. They will be central to the delivery of 'patient-centred' care and essential to supporting and monitoring the diabetes national service framework implementation. Widespread experience has identified three key principles. Firstly the need for a core data set that supports both service delivery and quality development. Secondly, because of the multiprofessional, multisector nature of diabetes care, there is a need to reconcile information from many diverse sources into unitary diabetes care records. Thirdly the crucial importance of making data collection a by-product of every day care delivery (i.e. no duplicate data entry). The work of many local innovators, allied to the increasing experience of the Diabetes UK sponsored UKDIABS project has generated substantial expertise. With the aid of new extraction/analysis tools such as QUIDS and a consistent approach to assessment, this work has hopefully laid secure foundations for monitoring the implementation of the national service framework. Furthermore, parallel developments under the aegis of the National electronic Library for Health (NeLH) should enable those involved with diabetes care to access relevant knowledge and information with ease. Increasingly user friendly ways by which patients can interact with their electronic records and linked knowledge sources will create many new opportunities. Diabetes information systems are likely to be at the forefront of diabetes care delivery in the future, providing patients and professionals with timely and accurate data for the organization and delivery of care.
 ...
PMID:The evolution of diabetes information systems. 1212 31

The issue of screening for diabetes raises questions about whether it is likely to be an effective use of NHS resources. However, by the time many people are diagnosed they have already developed complications. As certain groups are at increased risk of developing type 2 (non-insulin dependent) diabetes, screening may be an effective way to identify them before complications arise. Primary health care professionals have an important role to play in identifying patients with diabetes and helping them manage the condition, encouraging lifestyle changes in those at greatest risk.
 ...
PMID:Preventive action can enhance patient care. 1216 96

Lessons can often by learned by studying the outcomes of complaints made to the NHS by patients. We look at three recent investigations conducted and published by the Health Service Ombudsman. The first and second relate to poor care and lack of communication, and the third to care of a patient's diabetes and epilepsy in hospital and failure to record an outpatient consultation.
 ...
PMID:Inadequate nursing care and the failure to keep adequate records. 1263 Feb 48

Research suggests that people with diabetes are poorly compliant with dietary and exercise recommendations, and that primary non-compliance with medication is common. Local research has shown that patients' beliefs about diabetes suggest little understanding of the seriousness of the disease in terms of increased mortality. Portsmouth Primary Care Trust, in collaboration with Portsmouth Hospitals NHS Trust, is developing a range of structured self management programmes to assist in helping people be clearer about how they can make changes that will reduce their risk of diabetes complications and cardiovascular disease. These programmes are delivered to groups of patients, rather than on a single patient basis.
 ...
PMID:Helping patients to improve self management of diabetes. 1514 12

In the NHS, there is a perceived need for evidence-based guidelines to improve outcomes in all fields of health care. Management of the diabetic foot, which is a major public health problem, is one clinical field that needs quality guidelines. In response to this, the National Institute for Clinical Excellence (NICE) has published Clinical Guidelines for Type 2 Diabetes: Prevention and Management of Foot Problems (2004).
 ...
PMID:An evaluation of NICE guidelines on foot care for patients with diabetes. 1519 47

Diabetic and endocrine emergencies are traditionally treated by the acute medical admitting team or accident and emergency department staff. Most will see diabetic emergencies on a regular basis, as they are common and both type 1 and type 2 disease are increasing in prevalence. Diabetic emergencies are usually easily treated and the patients discharged. However, it is vital not to become complacent as these disorders can lead to death. It is particularly important to follow local guidance and to involve the diabetes team both during and after each episode. Recently it has become clear that about 30% of patients admitted with acute coronary syndrome (including infarction) have either diabetes or "stress hyperglycaemia"; evidence suggests that these patients should be treated not only as a cardiac emergency but also as a diabetic one. Thus, every patient with acute coronary syndrome or acute myocardial infarction needs diabetes to be excluded. The other endocrine emergencies are less common, but in some ways more important simply because of their rarity. A high level of suspicion is often required to make a diagnosis, although some, such as myxoedema coma, are usually obvious. Treatment must be started before the diagnosis can be confirmed. Guidance on making the diagnosis and initiating treatment should be made available on the local NHS intranet for non-endocrinologists to access; and where possible expert advice made available by telephone. The basic management steps in the common diabetic and endocrine emergencies are outlined; this is not a complete list, but rather an insight for those involved in non-selected emergency admissions.
 ...
PMID:Endocrine emergencies. 1535 51

Clinical assessment and management for anyone who has diabetes may be influenced by the development of the National Service Framework (NSF) for Diabetes. Through a case study, this article explains how the NSF for Diabetes and other recent NHS documentation has influenced our approach to managing a type 2 diabetic patient whose feet are categorised as 'high risk'. Some of the potential shortfalls of the NSF for Diabetes are also discussed in this context.
 ...
PMID:A clinical study and the national service framework for diabetes. 1551


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>