Clin Med
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Three documents have been produced in an attempt to increase the number of organs available for transplant: a National Institute for Health and Clinical Excellence (NICE) clinical guideline, a British Medical Association (BMA) report and a Welsh Government white paper. All three are ethically flawed: NICE and the BMA recommend that whenever there is intention to withdraw life-sustaining treatment and death is expected, patients should instead be stabilised to assess for donation. ⋯ Regarding consent, the BMA and Welsh Government recommend an 'opt-out' policy, but consent in law requires information and cannot be 'presumed' or 'deemed' on the basis of failure to express or register 'opting out'. The language of all three proposals is manipulative, and patient trust may be undermined because the doctor's attention must move from the interests of the patient to those of the unknown organ recipients.
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Hepatic cirrhosis secondary to excess alcohol consumption is increasing in incidence, and these patients can develop ataxia secondary to direct toxic effects of alcohol on the cerebellum. However, it is important to remain vigilant for other causes of an unsteady gait, including space-occupying lesions and medications, such as phenytoin. Patients with hypoalbuminaemia, such as those with cirrhosis, are more prone to developing toxic effects from phenytoin, as this Lesson describes. Therefore, dose adjustments might be necessary.
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Randomized Controlled Trial
Glycated albumin is a potential diagnostic tool for diabetes mellitus.
Using a community-based population cross-sectional study, we investigated the validity of an enzymatic method for glycated albumin (GA) measurements and evaluated its utility as a diagnostic tool for diabetes mellitus (DM). In total, 1,211 participants from the city of Harbin, People's Republic of China, were enrolled in the study. A receiver operating characteristic (ROC) analysis for GA, fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) measurements in diagnosed and undiagnosed DM were compared, based on a definition of DM using 1999 WHO criteria. ⋯ Significant and positive correlations of fasting serum GA with FPG (r = 0.8097) and HbA1c (r = 0.8976) were found in participants enrolled in the study. ROC analysis for GA predicting undiagnosed DM with a cut-off point of 15.7% was similar to that of FPG and HbA1c. Therefore, our data indicate that GA is a potential tool for DM diagnosis.