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The article reports the decision of the Court of Appeal (Criminal Division) in the case 'R. v Emsden (Kevin Russell)' concerning laws related to sentencing. It reports that allowing the appeal the court look carefully at any attempts to rely on mitigation arising post-sentence. It reports that the assistance given to the police or the Crown post-sentence would normally be too late, subject to certain exceptions.

This article reports that diabetes mellitus (DM), mainly type 2 diabetes, has affected approximately 100 million people worldwide, including 17 million in the U.S. and 1.15 million in Great Britain. A 30% increase in incidence is predicted by 2025, due to both the increased rate of obesity and the aging populations living in industrial countries. DM is a predictor of poor prognosis after acute myocardial infarction, congestive heart failure, and all modes of coronary revascularisation. Since the duration of DM is a powerful independent risk factor for coronary heart disease mortality, this conclusion needs further confirmation.

This articel focuses on a study that explores the impact of copying clinic letters to patients. The Great Britain National Health Service plan requires that, from April 2004, patients will hove the right to receive copies of au correspondence about them that is exchanged between healthcare professionals. researchers in the study demonstrates that the majority of patients appreciate receiving copies of their clinic letters and feel more informed as a result. There was also found no significant increase in workload for the clinic staff.

Nicola Brooks, Associate Dean, Faculty of Health and Life Sciences, De Montfort University, reflects on the potential problems that can occur with the administration of intravenous therapy.

Background: Transforming growth factor-beta1 (TGF-beta1) has been implicated in the pathogenesis of coronary vasculopathy following cardiac transplantation. The TGFB1 gene contains polymorphisms at positions +915* (Arg25Pro) and +869* (Leu10Pro) which may influence TGF-beta1 expression. We investigated the relationship between the development of coronary vasculopathy and the prevalence of these alleles in a cardiac transplant population., Methods: Vasculopathy was diagnosed at routine surveillance post-transplant coronary angiography. Using sequence-specific polymerase chain reaction we identified the TGFB1 +915* and +869* genotypes in 147 cardiac transplant recipients and 134 cardiac donors., Results: TGFB1 +915*C allele carriers (low producers) made up 10.5% of the recipient population but were significantly less likely to develop coronary vasculopathy (P=0.03). Median time to diagnosis was 6.0 years (3.9-8.72) in +915*C allele carriers compared to 2.75 years (2.10-4.22) in *G/G homozygotes (p=0.002). Pre- and 1 year post-transplant clinical variables were equivalent between the two groups. Multivariate analysis identified the recipient +915*G/G genotype (hazard ratio 2.96 (95% CI, 1.09-9.98); p=0.039), donor age (hazard ratio 1.05 (95% CI, 1.02-1.09); p=0.008) and number of acute rejection episodes of ISHLT grade 3 or greater in the first year (hazard ratio 1.12 (95% CI, 1.01-1.23); p=0.03) as significant predictors of vasculopathy. The recipient TGFB1 +869*, and both alleles in the donor, had no influence on vasculopathy development., Conclusions: Recipient TGFB1 +915* genotype influences the development of cardiac transplant-related coronary vasculopathy. This gives an important insight to the pathophysiology of the disease. On the contrary, donor TGFB1 +915* and TGFB1 +869* polymorphisms do not appear to be important and cannot be used as genetic risk factors.

Aim: To explore whether an intermediate care scheme could reduce the number of unnecessary emergency hospital admissions for people aged over 65., Method: A retrospective documentary analysis of 57 patients' discharge summaries was undertaken., Results: The analysis identified that only 7 per cent (n = 4) of these patients were re-admitted to hospital. These admissions appeared to be necessary in light of increasing clinical instability. Thirty three per cent (n = 19) of the patients required no further interventions to remain at home. Forty seven per cent (n = 27) of the patients that remained at home were referred to other agencies for ongoing care. The most common need identified was meeting patients' hygiene needs., Conclusion: This pilot evaluation identified that only 5 per cent of patients were re-admitted to hospital, which demonstrated great potential. The integration of a health and social care team appears to have resulted in a service with the skill, vision and resources to respond to older people's needs, ensuring that they are cared for, where appropriate, at home, with the right support.

Patient group directions (PGDs) have become a feature of NHS walk-in centres enabling nurses to supply and administer drugs in response to the generalised direction of a doctor. In light of the issues surrounding the use of antibiotics a clinical audit was undertaken to assess nurses' competence and record-keeping in relation to supplying antibiotics according to PGDs. This study goes some way to demonstrate that nurses are supplying and administering antibiotics judiciously and safely according to local PGDs.

The objective of this study was to assess the changes in outcome of cardiac arrest due to ventricular fibrillation, asystole and electromechanical dissociation in relation to the changing guidelines for drug therapy set by the U.K. Resuscitation Council. It was a retrospective study of 667 resuscitation records for the years 1982, 1986, 1988, 1989, 1990 and 1991. It took place in a large district general hospital with a regional cardio-thoracic centre. We have audited the asystolic cardiac arrests (N = 271) which occurred outside the cardiac care unit (CCU). Adrenaline (intravenous 1 mg) is now the first line drug followed by atropine at an increased dose (2 mg intravenously); calcium is no longer recommended and sodium bicarbonate should be reserved for cases in which an acidosis has been documented. Atropine use has increased over the 9-year period. Bicarbonate use did not change from 1982 to 1986 but fell progressively to no use at all in 1991. Calcium use has declined since 1982. Adrenaline use has remained unchanged. Survival from asystolic arrests (hospital discharge) has remained unchanged at 0-5.5%. Asystole as a primary event in the CCU was uncommon (N = 17) and no patient was discharged. Over the same period, 60% of patients (N = 92) with a cardiac arrest on CCU due to ventricular fibrillation (VF) were discharged and 55% were alive after 6 months. For VF on the wards (N = 192), only 20% of patients were discharged from hospital. A similar proportion was successful for each year.(ABSTRACT TRUNCATED AT 250 WORDS)