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Sexual dysfunction in men is well recognised but the effects of diabetes on women's sexual health is less researched and understood. Few women seek help for sexual problems and yet effective treatments may be available. Some genito-urinary diseases are more common in diabetes and the community nurse should consider this as part of the patient's assessment. Women with diabetes should be given appropriate advice on pregnancy. Community nurses have a major role to play in helping women with diabetes to talk freely about their sexuality and sexual health problems.

Objective: To evaluate the ability of two prognostic systems to predict hospital mortality in adult intensive care patients., Design: Prospective cohort study., Setting: A mixed medical and surgical intensive care unit (ICU) in the United Kingdom., Patients: A total of 1,144 patients consecutively admitted to the study., Interventions: None., Measurements and Main Results: Acute Physiology and Chronic Health Evaluation (APACHE) II and III prognostic systems were applied to assess probabilities of hospital mortality, which were compared with the actual outcome. The overall goodness-of-fit of both models was assessed. Hospital death rates were higher than those predicted by each system. Risk estimates showed a strong positive correlation between both systems (nonsurvivors r2 = 0.756, p < .0001; survivors r2 = 0.787, p < .0001). Calibration of APACHE II (chi 2 = 98.6, Lemeshow-Hosmer) was superior to that of APACHE III (chi 2 = 129.8, Lemeshow-Hosmer). The total correct classification rate of APACHE III was greater for all decision criteria applied; the best overall total correct classification rate was 80.6% for APACHE III and 77.9% for APACHE II (both for a decision criterion of 40%). The areas under the receiver operating characteristic curves were 0.806 and 0.847 for APACHE II and III, respectively, confirming the better discrimination of APACHE III. When patients were classified by diagnostic categories, risk predictions did not fit uniformly across the spectrum of disease groups. For both models, mortality ratios were highest for trauma patients and lowest for the group with respiratory disease. APACHE II predictions for patients with gastrointestinal disease were significantly better. Risk estimates for surgical admissions were superior with APACHE II (MR = 1.27) compared with APACHE III (MR = 1.56), but were similar for medical patients (1.22 vs. 1.28 for APACHE II and III, respectively). Bias induced by factors reflecting the clinical practice in an individual ICU (e.g., admission criteria, treatment before admission) may have considerable impact on risk estimates. The identification of such factors appears to be a prerequisite for the meaningful interpretation of observed and predicted death rates on the individual ICU level., Conclusions: Both predictive models demonstrated a similar degree of overall goodness-of-fit. APACHE II showed better calibration, but discrimination was better with APACHE III. Hospital mortality was higher than predicted by both models, but was underestimated to a greater degree by APACHE III. Risk estimates by both models showed considerable variation across the disease spectrum of ICU patients. Risk predictions for surgical patients and patients with gastrointestinal disease were better with APACHE II. Factors reflecting the clinical practice of an individual ICU are not accounted for by APACHE II and III. Overall, the performance of APACHE III was not superior to that of its predecessor for a cohort of United Kingdom ICU patients; for certain diagnostic categories, APACHE III performed worse than APACHE II despite an improved system of disease classification.

Outlines the integration of "Health of the Nation" and quality assurance into a health promotion strategy and reports on its implementation in a UK Health Trust. Presents and discusses strengths and weaknesses of such a health promotion strategy.

The admission of a child to the intensive care unit (ICU) is stressful for both the child and his family. Children are especially vulnerable to the psychosocial stressors associated with life-threatening illness and hospitalisation. The child's developmental immaturity may affect his ability to cope. Priority may be given by nursing staff to the child's physical care. Nursing care is only complete with consideration of the total needs of the child and family. Meeting the child's psychosocial needs will promote development and adaptation to critical illness and provide more holistic care for the family.

This study investigated whether serial daily measurements of serum C-reactive protein (sCRP) in 187 renal allograft recipients could help discriminate episodes of renal dysfunction due to rejection or cyclosporine (CsA) nephrotoxicity and help adjust immunosuppression in the early posttransplant period. Excellent primary graft function was associated with an initial peak of sCRP on day 2 after transplant (median, 29 microg/ml; range, 4 to >200 microg/ml) with a return to <20 microg/ml in all patients by day 5 (median, 7 microg/ml; range, 2-19 microg/ml). Stable graft function (mean creatinine, 155 microg/ml) was accompanied by a median sCRP of 4 microg/ml (range, 1-19 microg/ml). In 30 episodes of rejection responsive to methylprednisolone, sCRP was initially significantly raised to a median of 49 microg/ml (P<0.001) but fell rapidly in response to treatment to a median of 11 microg/ml and continued to fall. In 19 episodes of rejection unresponsive to methylprednisolone, median initial sCRP levels were significantly higher (P<0.001) at 119 microg/ml and were still at a median of 77 microg/ml at the end of the treatment. Twenty-four patients in whom renal dysfunction was associated with CsA nephrotoxicity showed no increase in sCRP concentrations; median sCRP concentrations remained at <5 microg/ml throughout the episodes. A similar pattern was seen in patients with acute tubular necrosis. Serial sCRP measurements provide economical and reproducible evidence of immune activation, help discriminate renal dysfunction due to CsA nephrotoxicity or rejection, and allow appropriate modification of immunosuppressive therapy.

We report a case of compartment syndrome complicating malignant hyperthermia (MH) in a 12-yr-old girl with a history of myopathy and multiple skeletal deformities; she underwent bilateral Achilles tendon surgery. Marked oedema of both forearms became evident in the immediate postoperative period and resolved after conservative treatment. Compartment syndrome is a rare complication of MH. Early recognition and therapy may prevent the onset of muscle ischaemia and distal neurovascular deficit. The need for urgent surgery and repeated anaesthesia in the early phase of recovery from an acute episode of MH may thus be reduced.

Epiglottitis is an acute life-threatening infectious condition characterised by local supraglottic inflammation. Although it is predominantly a disease of childhood, it occurs in all age groups. The risk of sudden complete airway obstruction necessitates careful monitoring, prompt responses and clinical expertise in airway management.