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Aim: Insulin is the preferred treatment for the control of diabetes in hospital, but it raises the risk of hypoglycaemia, often because oral intake of carbohydrates in hospitalized persons is lower than planned. Our aim was to assess the effect on the incidence of hypoglycaemia of giving prandial insulin immediately after a meal depending on the amount of carbohydrate ingested. Methods: A prospective pre–post intervention study in hospitalized persons with diabetes eating meals with stable doses of carbohydrates present in a few fixed foods. Foods were easily identifiable on the tray and contained fixed doses of carbohydrates that were easily quantifiable by nurses as multiples of 10 g (a 'brick'). Prandial insulin was given immediately after meals in proportion to the amount of carbohydrates eaten. Results: In 83 of the first 100 people treated with the 'brick diet', the oral carbohydrate intake was lower than planned on at least one occasion (median: 3 times; Q1–Q3: 2–6 times) over a median of 5 days. Compared with the last 100 people treated with standard procedures, postprandial insulin given on the basis of ingested carbohydrate significantly reduced the incidence of hypoglycaemic events per day, from 0.11 ± 0.03 to 0.04 ± 0.02 (P < 0.001) with an adjusted incidence rate ratio of 0.70 (95% confidence interval 0.54–0.92; P = 0.011). Conclusions: In hospitalized persons with diabetes treated with subcutaneous insulin, the 'brick diet' offers a practical method to count the amount of carbohydrates ingested, which is often less than planned. Prandial insulin given immediately after a meal, in doses balanced with actual carbohydrate intake reduces the risk of hypoglycaemia. What's new?: People with diabetes who are in hospital often do not eat their whole meal.In these cases, insulin treatment increases the risk of hypoglycaemia.The 'brick diet' allows nurses to easily count carbohydrates ingested so that insulin can be given accordingly.Postprandial insulin balanced against carbohydrate ingested reduces hypoglycaemic events. [ABSTRACT FROM AUTHOR]

Up to the 1930s, the Italian pictorialism movement dominated photography, and many handcrafted procedures started appearing. Each operator had his own working method and his own secrets to create special effects that moved away from the standard processes. Here, a methodology that combines X-ray fluorescence and infrared analysis spectroscopy with unsupervised learning techniques was developed on an unconventional Italian photographic print collection (the Piero Vanni Collection, 1889-1939) to unveil the artistic technique by the extraction of spectroscopic benchmarks. The methodology allowed the distinction of hidden elements, such as iodine and manganese in silver halide printing, or highlighted slight differences in the same printing technique and unveiled the stylistic practice. Spectroscopic benchmarks were extracted to identify the elemental and molecular fingerprint layers, as the oil-based prints were obscured by the proteinaceous binder. It was identified that the pigments used were silicates or iron oxide introduced into the solution or that they retraced the practice of reusing materials to produce completely different printing techniques. In general, four main groups were extracted, in this way recreating the 'artistic palette' of the unconventional photography of the artist. The four groups were the following: (1) Cr, Fe, K, potassium dichromate, and gum arabic bands characterized the dichromate salts; (2) Ag, Ba, Sr, Mn, Fe, S, Ba, gelatin, and albumen characterized the silver halide emulsions on the baryta layer; (3) the carbon prints were benchmarked by K, Cr, dichromate salts, and pigmented gelatin; and (4) the heterogeneous class of bromoil prints was characterized by Ba, Fe, Cr, Ca, K, Ag, Si, dichromate salts, and iron-based pigments. Some exceptions were found, such as the baryta layer being divided into gum bichromate groups or the use of albumen in silver particles suspended in gelatin, to underline the unconventional photography at the end of the 10th century.

Objective: To assess the effectiveness of a nurse-led class with phone follow-up, to help patients achieve lifestyle changes after an acute coronary syndrome (ACS)., Methods: Each patient < or = 75 years, admitted to a intensive cardiac care unit (ICCU) for ACS from September 2003 to December 2004, who attended the education class (case) was matched with two patients paired for age, sex and admission time, admitted for ACS to ICCUs in the other hospitals in the same area (controls). One year later the two groups were blindly interviewed on the phone, using a structured questionnaire about their lifestyles., Results: One-hundred-nineteen cases and 238 controls were phoned and 84% cases and 61% controls completed the interview. Cases reported a more correct lifestyle: they ate > or = 4 portions/day of fruit or vegetables (55% vs. 36%, p = 0.003) and > or = 2 portions/week of fish (48% vs. 32%, p = 0.010), reported > or = 30 min/day of physical activity (67% vs. 59%, p = 0.262) and stopped smoking (82% vs. 71% of previous smokers, p = 0.264)., Conclusion: An educational intervention led by cardiology nurses, with a group meeting and personal phone follow-up, improved lifestyle habits one year after an ACS.

Aim and Methods: The lifestyles before hospital admission, knowledge on their illness and lifestyles after the acute coronary event were analysed with questionnaires, in three different samples of patients: a. all the patients admitted for acute coronary event from may 2003 to may 2005 to explore lifestyles before acute coronary event (416 patients) b. all the patients admitted from may 2003 to april 2004 (before the start of health information meetings organised by nurses), to explore the knowledge of the illness and its causes (132 patients) c. a sample of 83 patients followed in day hospital, to explore the lifestyles after the acute coronary event., Results: Lifestyles before the event. Most patients have incorrect lifestyles: 50% eat cheese every day and never exercise for at least 30 minutes everyday. Even after the acute coronary event, some incorrect lifestyles are still present. Seventy-five percent of patients have incorrect or insufficient knowledge on illness and risk factors at discharge and only 50% is willing to increase the amount of fruit and vegetables in their diet., Conclusions: Although confirmed by other studies, these results are worrying and call for the systematic adoption of secondary prevention strategies with effective interventions aimed at increasing knowledge and modifying lifestyles.

Unlabelled: In spite of the broad recognition of the importance of health education, time for structured one-to -one initiatives of health education during the hospital stay is limited. The organization of an health education meeting for patients admitted to CCU for an acute coronary event is described., Methods: The planning and implementation of the initiative lasted two years and involved 7 nurses and one doctor. The organization required efforts related to the event itself (preparation of training aids, identification or contents and methods for delivery) but also organizative changes. Dietitians in fact had to be involved because the healthy diet recommended was different from the hospital diet. The assessment of the effectiveness of the health education was also planned: administration of a questionnaire to explore lifestyles and knowledge of the illness before and after the meeting; phone interviews after 3, 6 and 12 months from the meeting., Results: Since may 2003, in the first 3 years 74 meetings have been organised, involving 507 patients and 329 relatives. Each meeting lasts 2 hours and contents delivered encompass the coronary event, risk factors and their modification, healthy lifestyles. Initial preliminary results on the impact of the meeting on lifestyle changes are promising. Initiatives are ongoing to include this activity among officially recognised nursing activities.

Technetium-99m-labelled, non-specific, polyclonal, human immunoglobulin G (99mTc-hIG) has been used to quantify synovial inflammation in rheumatoid arthritis. A comparison was carried out between the scintigraphic results obtained with this tracer, 99mTc-hexamethylpropylene amine oxime-labelled white blood cells (99mTc-WBC) and 99mTc-albumin nanocolloids (99mTc-NC). Twenty patients affected by rheumatoid arthritis and suffering from clinically active synovitis were studied with 99mTc-hIG. The number and sites of the involved joints had been previously assessed on the basis of the presence of pain and/or swelling. A radiological examination had already been carried out on all the joints. Two days after the 99mTc-hIG scan, 10 patients (group 1) underwent 99mTc-WBC scintigraphy and the other 10 (group 2) underwent a 99mTc-NC scan. The results show that the results of 99mTc-hIG and 99mTc-NC scans are in agreement with clinical examinations in the majority of cases. However, a certain number of positive joint scans corresponding to negative clinical examinations was found. The numerical distribution of these results according to the radiological stages seems to show that 99mTc-hIG is more useful than 99mTc-NC in the initial phases of the disease. The 99mTc-WBC scan was negative in a consistent percentage of the joints previously assessed as clinically and 99mTc-hIG scan positive.

Blood clearance curves of 99mTc-HIDA have been evaluated in 18 healthy volunteers and 55 patients affected by chronic liver diseases. The slope (K) of the third exponential term of the blood clearance curve can be considered as an index of the 99mTc-diethyl-HIDA liver cell uptake; therefore, this parameter seems to be able to discriminate healthy volunteers from patients affected by hepatocellular dysfunction.