Postgraduate medical journal
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The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. ⋯ All of these treatments are still being refined, and it may be several decades before they are clinically useful. Prevention and cure of diabetes is the Holy Grail but remain elusive due to lack of detailed understanding of the metabolic, genetic and immunological causes that underpin diabetes. Much progress has been made since the time of Prof MacLean 90 years ago, but there are still great strides to be taken before the life of the patient with diabetes improves even more significantly.
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The worldwide prevalence of dementia is predicted to rise significantly in the next three decades. However, these projections have not taken into account the role of modifiable risk factors and whether any prevention strategies might influence the predicted trend. ⋯ In contrast, recent population studies in high-income countries suggest that the epidemiology may be changing with a possible decline in incident dementia, or even a reduction in age-specific prevalence. Therefore, efforts to develop public health interventions may prove to be the more successful approach to addressing dementia at a societal level.
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The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) age-based clinical prediction rules identify children at very low risk of a significant head injury who can safely avoid CT. Our goal was to independently validate these prediction rules. ⋯ In our external validation, the age-based PECARN TBI prediction rules accurately identified children at very low risk for a clinically significant TBI and can be used to assist CT decision making for children with minor blunt head trauma.