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    3974 results match your criteria Clinical Medicine [Journal]

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    Lesson of the month 2: Dry skin, yellow nails and breathlessness.
    Clin Med (Lond) 2017 Jul;17(4):371-372
    Southmead Hospital, Bristol, UK.
    Interstitial lung disease (ILD) is a common clinical problem, representing a group of diseases consisting of inflammation and progressive fibrosis of the lung. In some cases, an underlying cause is not identified; however, a significant proportion of ILD is associated with connective tissue disease (CTD). A detailed history and examination is the most important part of the assessment of patients with suspected ILD and will direct further investigation. Read More

    Lesson of the month 1: Large vessel vasculitis - a diagnostic challenge and the role of 18-fluorodeoxyglucose positron emission tomography.
    Clin Med (Lond) 2017 Jul;17(4):369-370
    Gloucestershire Royal Hospitals NHS Foundation Trust, Gloucester, UK.
    Large vessel vasculitis can pose a significant diagnostic challenge. It may be insidious in onset with the only presenting symptoms consisting of constitutional compromise. It may mimic other pathologies and the only serological abnormalities may be abnormal inflammatory markers. Read More

    The emergence of sarcopenia as an important entity in older people.
    Clin Med (Lond) 2017 Jul;17(4):363-366
    University of Dundee, Dundee, UK
    Sarcopenia refers to the loss of muscle mass and strength seen with advancing age. The pathophysiology is multifactorial, with loss of muscle satellite cells, changes in hormonal systems, chronic inflammation, oxidative stress and anabolic resistance to protein utilisation all implicated. Older age, female sex and immobility are important risk factors. Read More

    Prevention of falls in hospital.
    Clin Med (Lond) 2017 Jul;17(4):360-362
    Kent Community Health NHS Trust, Ashford, UK.
    Falls among inpatients are the most frequently reported safety incident in NHS hospitals. 30-50% of falls result in some physical injury and fractures occur in 1-3%. No fall is harmless, with psychological sequelae leading to lost confidence, delays in functional recovery and prolonged hospitalisation. Read More

    The physician's role in perioperative management of older patients undergoing surgery.
    Clin Med (Lond) 2017 Jul;17(4):357-359
    Guy's and St Thomas' NHS Foundation Trust, London, UK and King's College, London, UK.
    Life-sustaining and life-improving surgical interventions are increasingly available to older, frailer patients, many of whom have multimorbidity. Physicians can help support perioperative multidisciplinary teams with assessment and preoperative optimisation of physiological reserve, comorbidities and associated geriatric syndromes. Similar structured support can be useful in the postoperative period where older patients are at increased risk of delirium, medical complications, increased functional dependency and where discharge planning can prove more difficult than in younger cohorts. Read More

    Making difficult decisions with older patients on medical wards.
    Clin Med (Lond) 2017 Jul;17(4):353-356
    Nottingham University Hospitals NHS Trust, Nottingham, UK
    Decision making with older people can be difficult because of medical complexity, uncertainty (about prognosis, treatment effectiveness and priorities), difficulties brought by cognitive and communication impairment and the multiple family and other stakeholders who may need to be involved. The usual approach, based on balancing benefits and burdens of a treatment, and then deciding on the basis of autonomy (or best interests for someone lacking mental capacity), within the constraints of resources and equity, remains valid, but is often inadequate. In addition, approaches relying on optimal communication and relationship building and professional virtues are important. Read More

    Acute geriatrics at the front door.
    Clin Med (Lond) 2017 Jul;17(4):350-353
    Newcastle University, Newcastle upon Tyne, UK.
    Older people with frailty and urgent care needs are major uses of health and social care services. Comprehensive geriatric assessment (CGA) is an evidence-based approach to improving their outcomes, as well as improving service outcomes. Geriatricians form a small proportion of the overall workforce and cannot address the population need alone, so all clinicians (doctors, nurses, therapists and so on) need to engage in delivering CGA as a process of care, underpinned by specific competencies - which can be developed. Read More

    Heart failure - what's new and what's changed?
    Clin Med (Lond) 2017 Jul;17(4):341-346
    Hull York Medical School and honorary consultant cardiologist, Hull and East Yorkshire NHS Hospitals Trust, York, UK.
    Physicians responsible for the care of patients with heart failure due to left ventricular systolic dysfunction have access to a broad range of evidence-based treatments that prolong life and reduce symptoms. In spite of the significant progress made over the last four decades, there is an ongoing need for novel therapies to treat a condition that is associated with stubbornly high morbidity and mortality. In this article, we discuss the findings of SERVE-HF, a randomised controlled trial of adaptive servo-ventilation in patients with left ventricular systolic dysfunction, as well as EMPA-REG, a study of the effects of a novel diabetic agent that may be of greater interest to heart failure specialists than diabetologists. Read More

    The UK's multidisciplinary response to an Ebola epidemic.
    Clin Med (Lond) 2017 Jul;17(4):332-337
    Royal Free London NHS Foundation Trust, London, UK.
    The West African Ebola virus disease (EVD) epidemic was the largest and most devastating outbreak of EVD the world has ever seen. Its impact was felt far from the shores of Guinea, Liberia and Sierra Leone, with public health systems and clinicians across the globe confronted with an international response both in the affected region and within their own borders. The UK had a prominent role in response efforts, particularly in Sierra Leone. Read More

    When laboratory tests can mislead even when they appear plausible.
    Clin Med (Lond) 2017 Jul;17(4):329-332
    Wakefield, UK
    A laboratory test has three phases, pre-analytical, analytical and post-analytical. The purpose of this review is to highlight an issue concerning the analytical phase of one of the most widely deployed groups of in vitro diagnostic tests using a common technology - namely immunoassay.Immunoassay entails an inherently high error rate and, therefore, has the potential for inaccurate and misleading results susceptible to misinterpretation and/or diagnostic misapplication by clinicians. Read More

    Idiopathic inflammatory myopathies - a guide to subtypes, diagnostic approach and treatment.
    Clin Med (Lond) 2017 Jul;17(4):322-328
    NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
    The idiopathic inflammatory myopathies are a group of conditions characterised by inflammation of muscles (myositis) and other body systems. The diagnosis can be challenging because of the many potential clinical features and extra-muscular manifestations, which may be seemingly unrelated. An accurate diagnosis requires up-to-date understanding of the clinical manifestations, different clinical subtypes and appropriate interpretation of investigations, including newly described serological subtypes. Read More

    A contemporary review of peripartum cardiomyopathy.
    Clin Med (Lond) 2017 Jul;17(4):316-321
    Leeds General Infirmary, Leeds, UK.
    Peripartum cardiomyopathy reflects the presence of cardiac failure in the absence of determinable heart disease and occurs in late third trimester of pregnancy or up to 6 months postpartum. A full understanding of pathophysiological mechanisms is lacking, but excess prolactin levels, haemodynamic alterations, inflammation and nutritional deficiencies have all been implicated. Its clinical presentation has distinct overlap with physiological alterations in healthy pregnancy and this presents a diagnostic challenge. Read More

    Continuing professional development and Irish hospital doctors: a survey of current use and future needs.
    Clin Med (Lond) 2017 Jul;17(4):307-315
    University College Cork, Cork, Ireland.
    Doctors rate clinical relevance and applicability as the most important determinants of continuing professional development (CPD) course selection. This study examined patterns of current CPD practice and perceived CPD needs among hospital doctors in Ireland across various clinical specialties. A cross-sectional survey was administered to doctors, focusing on the areas of training needs analysis, CPD course content and preferred course format. Read More

    Evaluation of feedback given to trainees in medical specialties.
    Clin Med (Lond) 2017 Jul;17(4):303-306
    Centre for Medical Education, Queen's University Belfast, Belfast, UK.
    The aim of this study was to evaluate the quality of feedback provided to specialty trainees (ST3 or higher) in medical specialties during their workplace-based assessments (WBAs). The feedback given in WBAs was examined in detail in a group of 50 ST3 or higher trainees randomly selected from those taking part in a pilot study of changes to the WBA system conducted by the Joint Royal Colleges of Physicians Training Board. They were based in Health Education Northeast (Northern Deanery) and Health Education East of England (Eastern Deanery). Read More

    A hyperacute neurology team - transforming emergency neurological care.
    Clin Med (Lond) 2017 Jul;17(4):298-302
    Croydon University Hospital, Croydon, UK.
    We present the results of an 18-month study of a new model of how to care for emergency neurological admissions. We have established a hyperacute neurology team at a single district general hospital. Key features are a senior acute neurology nurse coordinator, an exclusively consultant-delivered service, acute epilepsy nurses, an acute neurophysiology service supported by neuroradiology and acute physicians and based within the acute medical admissions unit. Read More

    Monitoring risk factors of cardiovascular disease in cancer survivors.
    Clin Med (Lond) 2017 Jul;17(4):293-297
    Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, UK and Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
    There exist published literature for cardiovascular disease (CVD) risk monitoring in cancer survivors but the extent of monitoring in clinical oncology practice is unknown. We performed an interactive survey at a Royal College of Physicians conference (11 November 2016) attended by practitioners with an interest in late effects of cancer treatment and supplemented the survey with an audit among 32 lung cancer survivors treated at St Peter's NHS Hospital in 2012-2016. Among the practitioners, 40% reported CVD risk monitoring performed at least annually, which is compatible with European Group for Blood and Marrow Transplantation Guidelines, but 31% indicated that monitoring was never performed. Read More

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