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Clinical information systems and electronic records are starting to appear in secondary care and herald new potentials for improving health provision and capturing high quality data. In 2006, we set up a program to develop electronic patient records (EPR) for chronic disease using Cystic Fibrosis (CF) as our initial model. Seven years on we are now exploring the real time clinical data to identify risks, trends and outcomes in chronic disease management. We are also working to establish new models of integration and to connect information between the client and all areas of health care. [ABSTRACT FROM AUTHOR]

We have previously shown that 5-HT may play a role in the post-prandial exacerbation of symptoms seen in female patients with d-lBS. As both progesterone (P) and oestrogen (O) can influence the 5-HT system, the aim of th s study was to compare plasma 5-HT concentrations in female patients with d-lBS (Rome II) with high and ow levels of P/O. Platelet depleted plasma (PDP) 5-HT concentration was therefore assessed for 2 h (60 min intervals) under fasting conditions and 4 h (30 min intervals) after a standard carbohydrate meal (457 kcal) in 39 patients (aged 19-52 yrs) with high P/O (studied either during the luteal phase of the menstrual cycle or while taking combined P/O oral contraception) and in 11 aged matched patients (aged 22-45 years) with Iow P/O levels (menses). 5-HT concentration was measured by reverse-phase high performance liquid chromatography with fluorimetric detection. In addition, symptomatology (0-4; 4 = severe) was assessed throughout the study. Results: Under fasting conditions there was no difference in PDP 5-HT concentration between patients with a high (5.41 ng/ml, (mean)) and Iow (4.98 ng/ml; difference high Iow (95%CI), 0.43 ng/ml (-0.69,1.55) ng/ml; p = 0.443) P/O status. Following meal ingestion, however, patients with high P/O levels have a significantly higher PDP 5-HT peak (13.99 ng/ml; (geometric mean) than those with Iow P/O levels (8.57 ng/ml; ratio high:low, 1.63 (1.02,2.62); p = 0.043). This difference was particularly evident in patients reporting post-prandial symptoms (patients with high P/O levels (n = 31): 15.60 ng/ml v patients with Iow P/O levels (n = 11): 8.57 ng/ml; ratio high:low, 1.82 (1.12, 2.96); p = 0.017) and was not related to a difference in symptom severity between the two groups (patients with high P/O levels: 0.70 (mean) v Iow P/E levels: 0.58; difference highIow, 0.12 (-0.28, 0.53); p = 0.547. Conclusions: Female sex hormones may play a role in the gastrointestinal tract 5-HT response to a meal in female... [ABSTRACT FROM AUTHOR]

Recent studies suggest that patients with irritable bowel syndrome lBS have elevated levels of plasma 5-HT following meal ingestion compared with healthy controls. Moreover, patients who exhibit postprandial symptoms have higher plasma 5-HT levels compared with those who do not, suggesting a possible relationship between Dost-prandial symptoms and abnormalities in 5-HT release. Given functional dyspepsia (FD) belongs to the same family of disorders as lBS, the aims of this study were to assess platelet depleted plasma (PDP) 5-HT concentrations under fasting and fed (760 kcal meal) conditions in 11 patients with FD (aged 30-61 years; 6 males) and 12 healthy volunteers (aged 20-48 years; 5 males) and assess any relationship to gender and epigastric pain/discomfort (p/d). Results: Under fasting conditions FD patients had similar levels of PDP 5-HT to controls (FD (n = 11): 4.65 ng/ml (geometric mean) vs controls (n = 12): 4.57ng/ml; ratio FD:controls (95%CI), 1.02 (0.14, 1.26)). However, under fed conditions, although the peak PDP 5-HT concentration for the whole group of FD patients was not significantly different from controls (11.19 ng/ml vs 8.43 ng/ml; 1.33(0.69, 2.54); p = 0.37, patients who reported post-prandial p/d had a higher PDP 5-HT peak (n = 8:14.74 ng/ml) than both patients who did not report p/d (5.36ng/ml; ratio with:without p/d 2.75(1.24, 6.10); p = 0.02) and controls (8.43 ng/ml; ratio FD with p/d:controls, 1.75 (0.79, 3.87); p = 0.14). This was as a consequence of a higher PDP 5-HT peak in the female FD patients with p/d (36.56 ng/ml), as all other females (FD and controls (n = 9): 7.71 ng/ml; ratio FD with p/d:FD and controls 4.74 (2.5, 9.0 p < 0.001) and all males (FD and contro s (n = 11): 8.07 ng/ml; ratio female FD with p/d: all males, 4.53 (2.19,9.35); p < 0.001) had lower PDP 5-HT peaks. Lastly, symptom severity tended to correlate with peak PDP 5-HT concentration (rho = 0.37; p = 0.08). Conclusions: These data provide evidence for a role... [ABSTRACT FROM AUTHOR]