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Darukhanavala A, Puhr S, Dinunno K, Alfego D, Welsh J, Butler L, Magyar K. Association between attendance at an American diabetes camp and improvements in glycaemic control and treatment satisfaction. Endocrinol Diabetes Metab 2021; 4:e00254. [PMID: 34277978 PMCID: PMC8279631 DOI: 10.1002/edm2.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Few studies have evaluated glycaemic control using continuous glucose monitoring (CGM) in individuals before and after attendance at a diabetes camp or by comparing control groups at home to control groups at camp. Methods Youth (6–17 years) with T1D and receiving insulin therapy were enrolled at a week‐long diabetes camp. They participated in three clinic visits: at the start of a week at home, by initiating a Dexcom G6 CGM system; at the start of a week at camp, where the home week G6 was removed and a camp week G6 was inserted; and after camp, where the camp week G6 was removed. We administered Problem Areas in Diabetes (PAID) surveys at the second and third visits. Participants with <80% CGM data coverage or who did not complete all PAID surveys were excluded from analysis. We compared glycaemic control and PAID scores between the week at home and week at camp. Results Of 76 enrolled campers, 69 completed the study and 52 had results that qualified for analysis. The mean participant age was 12.5 ± 2.2 years. Camp was associated with significantly improved treatment satisfaction, time in desired glucose range and insulin sensitivity. Time in hyperglycaemia and basal insulin requirements decreased significantly. Conclusions Diabetes camp is associated with significant improvements in diabetes treatment satisfaction and glycaemic control compared to home care.
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Affiliation(s)
- Amy Darukhanavala
- Division of Pediatric Endocrinology UMass Medical Center Worcester MA USA
| | | | - Kyle Dinunno
- The Barton Center for Diabetes Education North Oxford MA USA
| | - David Alfego
- Division of Pediatric Endocrinology UMass Medical Center Worcester MA USA
| | | | - Lynn Butler
- The Barton Center for Diabetes Education North Oxford MA USA
| | - Kendra Magyar
- The Barton Center for Diabetes Education North Oxford MA USA
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Erbas IM, Abaci A, Anik A, Simsek E, Tuhan HU, Kocyigit C, Yıldız M, Dundar BN, Bober E, Catli G. Comparison of the effectiveness of simple carbohydrates on hypoglycemic episodes in children and adolescents with type 1 diabetes mellitus: A randomized study in a diabetes camp. Pediatr Diabetes 2020; 21:1249-1255. [PMID: 32662200 DOI: 10.1111/pedi.13077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hypoglycemia is the most common and severe complication of insulin treatment during the management of type 1 diabetes mellitus (T1DM). Despite its importance, there is a lack of data about the efficacy and superiority of the carbohydrate sources used in hypoglycemia management in children and adolescents. OBJECTIVE We aimed to compare the effectiveness of honey, fruit juice, and sugar cubes as simple carbohydrates used in the primary treatment of hypoglycemia in children and adolescents with T1DM, who attended a diabetes summer camp. METHODS A prospective randomized study was performed in a 5-days-long diabetes summer camp. Three different types of simple carbohydrates; sugar cubes, honey, or fruit juice were randomly given for the treatment of hypoglycemia and the recovery results in the three groups were compared. RESULTS About 32 patients (53.1% male, mean age 12.9 ± 1.9 years) were included and 158 mild hypoglycemic episodes were observed. Sugar cubes, honey, and fruit juice were given in 46 (29.1%), 60 (37.9%), and 52 (33%) events, respectively. We found that honey and fruit juice had similar efficiency in recovering hypoglycemia in 15 minutes with a rate of 95% and 98%, respectively. However, sugar cubes had a significantly lower impact on treatment of hypoglycemia than the others, with a recovery rate of 84.7% at 15 minutes. CONCLUSIONS This study showed, for the first time, that honey and fruit juice were more effective in treating hypoglycemia than sugar cubes, and can be preferred in treating hypoglycemic events in children and adolescents with T1DM.
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Affiliation(s)
- Ibrahim Mert Erbas
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ayhan Abaci
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Anik
- Division of Pediatric Endocrinology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Erdem Simsek
- Department of Pediatrics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Hale Unver Tuhan
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Cemil Kocyigit
- Division of Pediatric Endocrinology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Melek Yıldız
- Division of Pediatric Endocrinology, Dr Behçet Uz Children's Hospital, İzmir, Turkey
| | - Bumin Nuri Dundar
- Division of Pediatric Endocrinology, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Ece Bober
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Gonul Catli
- Division of Pediatric Endocrinology, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
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Lo HL, Adhikari S, White PC, Grishman EK, Gupta OT. Impact of insulin reduction on glycemic control in children attending a residential diabetes camp. Pediatr Diabetes 2019; 20:1094-1099. [PMID: 31456281 DOI: 10.1111/pedi.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/10/2019] [Accepted: 08/17/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/OBJECTIVES Children attending diabetes camp are more active, increasing the risk of hypoglycemia. Decreasing initial insulin doses may reduce this risk. The objectives of our study were to compare glycemic control between campers receiving multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII), and analyze the impact of decreasing basal insulin by 10%. METHODS We analyzed 849 camp sessions (599 children, 5-19 years old) from Camp Sweeney's 2016/2017 summers. Campers were separated into groups by year and insulin route (MDI_2016, MDI_2017, CSII_2016, and CSII_2017). The MDI_2016 group had initial basal insulin decreased 10%, while CSII_2016, MDI_2017, and CSII_2017 did not. Time spent in blood glucose ranges and area under the curve (AUC) were compared by year and insulin route using ANOVA. We also performed repeated measures ANOVA using campers who attended both years. RESULTS No significant differences in time spent in any glucose range could be attributed to the initial 10% basal decrease, including on paired analysis. MDI_2017 had more decreases to basal insulin than the other groups. CSII campers had higher AUC and more hyperglycemia than MDI campers. CONCLUSIONS Campers on MDI may benefit from decreasing basal insulin, either at the beginning of camp or during the first week. Future research is needed to optimize glycemic control in the camp setting.
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Affiliation(s)
- Huay-Lin Lo
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Soumya Adhikari
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Perrin C White
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ellen K Grishman
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Olga T Gupta
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Texas Southwestern Medical Center, Dallas, Texas
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Mann EA, Lunos S, Carrel E, Omann T, Halper A, Kogler A, Miller BS, Sunni M, Bellin MD, Nathan BM. Establishing the incidence and timing of hypoglycemia at a residential diabetes camp. Diabetes Res Clin Pract 2019; 151:146-151. [PMID: 30951794 PMCID: PMC6687467 DOI: 10.1016/j.diabres.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/23/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Abstract
AIMS To establish the incidence and timing of hypoglycemia at a week-long residential diabetes camp for children. We hypothesized that hypoglycemia would occur more frequently during the first two days of camp and following evening all-camp games. METHODS 225 children (mean age 12.0 ± 2.3 years, 56% female, mean hemoglobin A1c 8.4% [71.6 mmol/mol]) had blood glucose (BG) levels obtained before meals, at bedtime, and as needed to detect hypoglycemia. Insulin adjustments were made by medical staff according to camp protocol and at the discretion of medical staff during camper check-in. RESULTS Mild hypoglycemia (BG 50-69 mg/dL [3.9 mmol/L]) occurred ≥ 1 time in 90% of campers while 43% had ≥ 1 episode of BG < 50 mg/dL (2.8 mmol/L). No episodes of hypoglycemia requiring glucagon occurred. More campers experienced ≥ 1 overnight hypoglycemia event during the first 48 hours of camp compared to later in the week (p = 0.01). Evening all-camp games did not impact hypoglycemia rates overnight. CONCLUSIONS Nocturnal hypoglycemia occurred more frequently during the first two nights, establishing this period as high risk and supporting implementation of a standard protocol to lower insulin doses. Rates of hypoglycemia were unaffected by all-camp games, indicating current practices are effective at minimizing hypoglycemia.
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Affiliation(s)
- Elizabeth A Mann
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, United States
| | - Scott Lunos
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN 55455, United States
| | - Elijah Carrel
- Brown University, Providence, RI 02912, United States
| | - Trevor Omann
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, United States
| | - Alyssa Halper
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, United States; Division of Pediatric Endocrinology, University of Minnesota, Minneapolis, MN 55454, United States
| | - Anne Kogler
- Division of Pediatric Endocrinology, University of Minnesota, Minneapolis, MN 55454, United States
| | - Bradley S Miller
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, United States; Division of Pediatric Endocrinology, University of Minnesota, Minneapolis, MN 55454, United States
| | - Muna Sunni
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, United States; Division of Pediatric Endocrinology, University of Minnesota, Minneapolis, MN 55454, United States
| | - Melena D Bellin
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, United States; Division of Pediatric Endocrinology, University of Minnesota, Minneapolis, MN 55454, United States
| | - Brandon M Nathan
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, United States; Division of Pediatric Endocrinology, University of Minnesota, Minneapolis, MN 55454, United States.
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Park SY, Kim SY, Lee HM, Hur KY, Kim JH, Lee MK, Sim KH, Jin SM. Diabetes Camp as Continuing Education for Diabetes Self-Management in Middle-Aged and Elderly People with Type 2 Diabetes Mellitus. Diabetes Metab J 2017; 41:99-112. [PMID: 28447438 PMCID: PMC5409007 DOI: 10.4093/dmj.2017.41.2.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 11/18/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite the established benefits of diabetes camps for the continuing education of children with type 1 diabetes mellitus, little is known about the long-term metabolic benefits of diabetes camps for middle-aged and elderly people with type 2 diabetes mellitus (T2DM), especially in terms of glycosylated hemoglobin (HbA1c) variability. METHODS The 1-year mean and variability of HbA1c before and after the diabetes camp was compared between the participants of the diabetes camp (n=57; median age 65 years [range, 50 to 86 years]; median diabetes duration 14 years [range, 1 to 48 years]). Additional case-control analysis compared the metabolic outcomes of the participants of the diabetes camp and their propensity score-matched controls who underwent conventional diabetes education (n=93). RESULTS The levels of HbA1c during the first year after the diabetes camp were comparable to those of the matched controls (P=0.341). In an analysis of all participants of the diabetes camp, the 1-year mean±standard deviation (SD) of HbA1c decreased (P=0.010 and P=0.041) after the diabetes camp, whereas the adjusted SD and coefficient of variance (CV) of HbA1c did not decrease. The adjusted SD and CV significantly decreased after the diabetes camp in participants whose 1-year mean HbA1c was ≥6.5% before the diabetes camp (n=40) and those with a duration of diabetes less than 15 years (n=32). CONCLUSION The 1-year mean and SD of HbA1c decreased after the diabetes camp, with significant reduction in the adjusted SD and CV in those with higher baseline HbA1c and a shorter duration of diabetes.
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Affiliation(s)
- So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Young Kim
- Diabetes Education Unit, Diabetes Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Mi Lee
- Diabetes Education Unit, Diabetes Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kang Hee Sim
- Diabetes Education Unit, Diabetes Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sang Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Dehayem MY, Takogue R, Choukem SP, Donfack OTS, Katte JC, Sap S, Sobngwi E, Mbanya JC. Impact of a pioneer diabetes camp experience on glycemic control among children and adolescents living with type 1 diabetes in sub-Saharan Africa. BMC Endocr Disord 2016; 16:5. [PMID: 26791079 PMCID: PMC4721200 DOI: 10.1186/s12902-016-0086-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The metabolic impact of participating in a diabetes camp is little known among children and adolescents living with type 1 diabetes in sub-Saharan Africa. We aimed to assess the changes in glycemic control and insulin doses in a group of children and adolescents living with type 1 diabetes in Cameroon during and after camp attendance. METHODS During a 5-day camp, we collected data on insulin doses, HbA1c, weight and blood glucose at least six times per day in a group of children and adolescents living with type 1 diabetes. We compared the evolution of these parameters 3 and 12 months after camp. RESULTS Thirty-two campers completed the study. The mean age was 19 ± 2 years and the median duration of diabetes was 2 [IQR: 1.8-5] years. The mean HbA1c was 7.9 ± 2.2 % and the mean insulin dose was 49 ± 20 units/day upon arrival at camp. HbA1c dropped by 0.6 % after 12 months (p = 0.029). Despite the significant (p = 0.04) reduction in insulin dose from 49 ± 20 to 44 ± 18 units/day at the end of camp, hypoglycemic episodes occurred in 26 campers. However, the mean number of hypoglycemic episodes reduced from 1.32 (range: 0-4) on the first day, to 0.54 (range: 0-2) on the last day of camp (p = 0.006). Weight increased by 6 kg (p = 0.028) between 3 and 12 months after camp, but insulin doses remained unchanged. CONCLUSIONS Attending camp for children and adolescents living with diabetes is associated with a significant decrease in HbA1c twelve months after camp without changes in insulin doses. Including camps as an integral part of type 1 diabetes management in children and adolescents in sub-Saharan Africa may yield some benefits. TRIAL REGISTRATION ClinicalTrials.gov NCT02632032 . Registered 4 December 2015.
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Affiliation(s)
- Mesmin Y Dehayem
- Endocrine and Diabetes Service, Yaoundé Central Hospital, PO Box 87, Yaoundé, Cameroon.
| | - Rémy Takogue
- Endocrine and Diabetes Service, Yaoundé Central Hospital, PO Box 87, Yaoundé, Cameroon.
| | - Siméon-Pierre Choukem
- Health and Human Development Research Group, Douala, Cameroon.
- Diabetes and Endocrine Unit, Internal Medicine Service, Douala General Hospital, Douala, Cameroon.
- Department of Internal Medicine and Pediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
| | - Olivier T S Donfack
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon.
| | | | - Suzanne Sap
- Mother and Child Centre, Chantal Biya Foundation, Yaoundé, Cameroon.
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Eugène Sobngwi
- Endocrine and Diabetes Service, Yaoundé Central Hospital, PO Box 87, Yaoundé, Cameroon.
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon.
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | - Jean-Claude Mbanya
- Endocrine and Diabetes Service, Yaoundé Central Hospital, PO Box 87, Yaoundé, Cameroon.
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon.
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
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Lange K, Swift P, Pańkowska E, Danne T. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes education in children and adolescents. Pediatr Diabetes 2014; 15 Suppl 20:77-85. [PMID: 25182309 DOI: 10.1111/pedi.12187] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Karin Lange
- Department of Medical Psychology, Hannover Medical School, OE 5430, 30625, Hannover, Germany
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Zhao Q, Chen S, Huang H, Zhang L, Wang L, Liu F, Chen J, Zeng Y, Chu PK. Colorimetric and ultra-sensitive fluorescence resonance energy transfer determination of H2O2 and glucose by multi-functional Au nanoclusters. Analyst 2014; 139:1498-503. [DOI: 10.1039/c3an01906c] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Colver A, Longwell S. New understanding of adolescent brain development: relevance to transitional healthcare for young people with long term conditions. Arch Dis Child 2013; 98:902-7. [PMID: 23986559 PMCID: PMC4096849 DOI: 10.1136/archdischild-2013-303945] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Whether or not adolescence should be treated as a special period, there is now no doubt that the brain changes much during adolescence. From an evolutionary perspective, the idea of an under developed brain which is not fit for purpose until adulthood is illogical. Rather, the adolescent brain is likely to support the challenges specific to that period of life. New imaging techniques show striking changes in white and grey matter between 11 and 25 years of age, with increased connectivity between brain regions, and increased dopaminergic activity in the pre-frontal cortices, striatum and limbic system and the pathways linking them. The brain is dynamic, with some areas developing faster and becoming more dominant until other areas catch up. Plausible mechanisms link these changes to cognitive and behavioural features of adolescence. The changing brain may lead to abrupt behavioural change with attendant risks, but such a brain is flexible and can respond quickly and imaginatively. Society allows adolescent exuberance and creativity to be bounded and explored in relative safety. In healthcare settings these changes are especially relevant to young people with long term conditions as they move to young adult life; such young people need to learn to manage their health conditions with the support of their healthcare providers.
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Affiliation(s)
- Allan Colver
- Professor of Community Child Health, Institute of Health and Society, Newcastle University, James Spence Building, Royal Victoria Infirmary Newcastle NE1 4LP
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