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Articles by N. Lee
Total Records ( 3 ) for N. Lee
  M. G ISON and N. LEE
 

Much was learned about the diagnosis, management, and pathogenesis of influenza from the 2009 pandemic of influenza A (H1N1). This knowledge can be applied to the management of people affected by seasonal infection and to future pandemics.

  S. L. Norris , N. Lee , S. Thakurta and B. K. S. Chan
  Objective  To examine the efficacy, effectiveness and side effects of exenatide when compared with oral glucose-lowering agents or insulin therapy.

Research design and methods  Relevant citations were identified from searches of multiple bibliographic databases supplemented with searches of the US Food and Drug Administration website and other sources. A qualitative synthesis was performed, with a random effects meta-analysis when appropriate.

Results  We identified 17 studies. In placebo-controlled trials of subjects with poorly controlled diabetes (with both groups receiving various oral glucose-lowering agents), exenatide 10 μg twice daily improved glycated haemoglobin (HbA1c) by approximately 1.0% over 30 weeks [pooled estimate −0.97%, 95% confidence interval (CI), −1.16 to −0.79%, P < 0.0001] and exenatide treatment over 16-30 weeks was associated with weight loss of 1.0-2.5 kg. Exenatide appeared to confer a similar benefit to various insulin regimes for glycaemic control at follow-up between 16 and 52 weeks (pooled estimate HbA1c−0.04%, 95% CI, −0.14 to 0.06%, P = 0.41), but was advantageous over insulin with respect to weight loss (3-6 kg loss at up to 52 weeks of follow-up). Nausea was the most common adverse event in placebo- and active-controlled trials. Rates of hypoglycaemia were similar in exenatide and insulin groups, but were higher with exenatide 10 μg twice daily compared with placebo and hypoglycaemia was most frequent when a sulphonylurea was administered.

Conclusions  In subjects with poorly controlled diabetes, exenatide was associated with a reduction in HbA1c that was similar to introducing another oral agent or insulin. Weight loss may be an advantage with exenatide. Long-term studies in diverse and unselected populations are needed to clarify the benefit vs. harm profile of this drug.

  K. A. Goatman , S. Philip , A. D. Fleming , R. D. Harvey , K. K. Swa , C. Styles , M. Black , G. Sell , N. Lee , P. F. Sharp and J. A. Olson
  Aims  To develop and evaluate an image grading external quality assurance system for the Scottish Diabetic Retinopathy Screening Programme.

Method  A web-based image grading system was developed which closely matches the current Scottish national screening software. Two rounds of external quality assurance were run in autumn 2008 and spring 2010, each time using the same 100 images. Graders were compared with a consensus standard derived from the top-level graders' results. After the first round, the centre lead clinicians and top-level graders reviewed the results and drew up guidance notes for the second round.

Results  Grader sensitivities ranged from 60.0 to 100% (median 92.5%) in 2008, and from 62.5 to 100% (median 92.5%) in 2010. Specificities ranged from 34.0 to 98.0% (median 86%) in 2008, and 54.0 to 100% (median 88%) in 2010. There was no difference in sensitivity between grader levels, but first-level graders had a significantly lower specificity than level-two and level-three graders. In 2008, one centre had a lower sensitivity but higher specificity than the majority of centres. Following the feedback from the first round, overall agreement improved in 2010 and there were no longer any significant differences between centres.

Conclusions  A useful educational tool has been developed for image grading external quality assurance.

 
 
 
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