Internal Medicine Journal 

Abstract: This study examined the association of diabetes with the onset of dementia (including Alzheimer's disease (AD), vascular dementia (VD) and any dementia) and mild cognitive impairment (MCI) by using a quantitative meta-analysis of longitudinal studies EMBASE and MEDLINE were searched for articles published up to December 2010 All studies that examined the relationship between diabetes and the onset of dementia or MCI were included Pooled relative risks were calculated using fixed and random effects models Nineteen studies met our inclusion criteria for this meta-analysis, and 6184 subjects with diabetes and 38 530 subjects without diabetes were included respectively All subjects were without dementia or MCI at baseline The quantitative meta-analysis showed that subjects with diabetes had higher risk for AD (relative risk (RR):146, 95% confidence interval (CI): 120–177), VD (RR: 248, 95% CI: 208–296), any dementia (RR: 151, 95% CI: 131–174) and MCI (RR: 121, 95% CI: 102–145) than those without The quantitative meta-analysis showed that diabetes was a risk factor for incident dementia (including AD, VD and any dementia) and MCI

Abstract: Background: Recent studies have suggested there are a large number of potentially preventable deaths in Australian hospitals. Aim: This study aimed to document antecedent factors in hospital deaths in an attempt to identify potentially preventative factors. Methods: The study was conducted at three separate acute hospitals. Demographics of all deaths were recorded over a 6-month period as well as antecedent factors present within 0‐8 and 8‐48 h of all deaths including vital sign abnormalities, cardiorespiratory arrests and admission to intensive care. Separate analysis was performed on ‘not for resuscitation’ deaths. Results: There were a total of 778 deaths, of which 549 (71%) were ‘not for resuscitation’. There were 171 (22%) deaths preceded by arrest and 160 (21%) preceded by admission to intensive care. Of the remaining deaths, 30% had severely abnormal physiological abnormalities documented. This incidence was 50% in the non-do not resuscitate (DNR) subgroup. Concern about the patient’s condition was expressed in the patient’s notes by attending nursing staff and junior medical staff in approximately onethird of non-DNR deaths. Hypotension (30%) and tachypnoea (17%) were the most common antecedents in the non-DNR deaths. Conclusion: There is a high incidence of serious vital sign abnormalities in the period before potentially preventable hospital deaths. These antecedents may identify patients who would benefit from earlier intervention. (Intern Med J 2001; 31: 343‐348)

Abstract: Measurement of exercise capacity is an integral element in assessment of patients with cardiopulmonary disease. The 6-min walk test (6MWT) provides information regarding functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. A distance less than 350 m is associated with increased mortality in chronic obstructive pulmonary disease, chronic heart failure and pulmonary arterial hypertension. Desaturation during a 6MWT is an important prognostic indicator for patients with interstitial lung disease. The 6MWT is sensitive to commonly used therapies in chronic obstructive pulmonary disease such as pulmonary rehabilitation, oxygen, long-term use of inhaled corticosteroids and lung volume reduction surgery. However, it appears less reliable to detect changes in clinical status associated with medical therapies for heart failure. A change in walking distance of more than 50 m is clinically significant in most disease states. When interpreting the results of a 6MWT, consideration should be given to choice of predictive values and the methods by which the test was carried out.