Postgraduate medical journal
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Diabetic ketoacidosis, hyperglycaemic hyperosmolar state, and lactic acidosis represent three of the most serious acute complications of diabetes. There have been some advances in our understanding of the pathogenesis of these conditions over the last three decades, together with more uniform agreement on their treatment and innovations in technology. ⋯ In this article, understanding of these conditions and advances in their management, and the available guidelines for their treatment, are reviewed. As far as is possible, the recommendations are based on clear published evidence; failing that, what is considered to be a common sense synthesis of consensus guidelines and recommendations is provided.
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To compare the views of doctors and patients on whether doctors should wear white coats and to determine what shapes their views. ⋯ In contrast to doctors, who view white coats as an infection risk, most patients, and especially those older than 70 years, feel that doctors should wear them for easy identification. Further studies are needed to assess whether this affects patients' perceived quality of care and whether patient education will alter this view.
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The tumour associated CA-125 antigen is widely used in monitoring ovarian carcinoma. In women with a massive pleural effusion and ascites, markedly increased CA-125 levels may lead to an erroneous diagnosis of ovarian cancer. Very high levels of tumour markers may be present in patients with benign pleural effusion, ascites, and chronic liver disease. Raised levels of tumour markers in serum or pleural fluid, in the absence of positive cytology, should be interpreted with caution.
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Four theoretical ethical perspectives on professional-patient relationships-autonomy, justice, virtue ethics, and the ethic of care-are surveyed, and some of their implications for the informed consent requirement in health care are sketched out. The practical issues of competence to consent, adequate information, and voluntariness are reviewed, and examples are given of the ways in which the theoretical perspectives outlined earlier might inform practice in areas such as these. Finally, the situation of patients not competent to consent is considered in the light of the same theoretical perspectives.
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The diagnosis of tuberculous aetiology in pericardial effusions is important since the prognosis is excellent with specific treatment. The clinical features may not be distinctive and the diagnosis could be missed particularly with tamponade. ⋯ Histopathology may, however, show non-specific findings in a significant number. This review is an update on the diagnostic difficulties, current research, and criteria for diagnosis.