Postgraduate medical journal
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Review Case Reports
Cold damage to the extremities: frostbite and non-freezing cold injuries.
The treatment of cold injuries to the periphery has advanced substantially in the last 10 years and optimal outcomes are only likely to be achieved if a multidisciplinary team uses the full range of diagnostic and treatment modalities that are now available. The internet and satellite phones with digital images allow immediate access by patients from remote geographical locations to hospital based specialists who can assess cold injuries and advise on early field care. ⋯ Early hyperbaric oxygen therapy appears to improve outcome and the use of intravenous drugs such as synthetic prostaglandin analogues infusions and tissue plasminogen activator have been shown to reduce amputation rates. In non-freezing cold injuries the early administration of analgesia, the avoidance of secondary exposure, and the use of infrared thermography to assess the injuries are among newer approaches being introduced.
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Delirium is a common condition in the elderly, affecting up to 30% of all older patients admitted to hospital. There is a particularly high risk of delirium in surgical inpatients, especially following operations for hip fracture or vascular surgery, but also for patients in the intensive care unit. ⋯ Recent evidence suggests that a better understanding and knowledge of delirium among health care professionals can lead to early detection, the reduction of modifiable risk factors, and better management of the condition in the acute phase. Many cases of delirium are potentially preventable, and primary and secondary care services should be taking active steps in order to do prevent this condition.
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Lung cancer is the most common cancer worldwide and causes more deaths per year than any other cancer. It has a very poor 5-year survival rate of 8-16%, partly because of comorbidity preventing curative treatments but mainly because of the disease presenting with symptoms only when it is at an advanced and incurable stage. When lung cancer is detected earlier and is amenable to radical treatments such as potentially curative surgery and radical radiotherapy, 5-year survival rates are much higher (up to 67%). ⋯ The lack of impact achieved by early studies using sputum cytology (in conjunction with chest radiographs) is described, and then newer technology used to measure other biomarkers in sputum, serum, exhaled breath and bronchial mucosa to diagnose (early) lung cancer is detailed. Many techniques show promise, but debate continues about which population to screen and what is the most (cost) effective modality to use. Moreover, no single biomarker or combination of biomarkers in screening has yet been shown to reduce lung cancer mortality in large prospective randomised studies.
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As a relative shortage of organs limits transplantation rates in many countries, the number of patients on dialysis is increasing. Nephrologists in specialist centres supervise their dialysis, but increasingly in the context of acute medical emergencies, such patients present to district general hospitals. Experience in managing patients on dialysis varies among institutions. This review aims to provide a practical guide to aid general physicians involved in the delivery of hospital care, by outlining the principles of dialysis (haemodialysis and peritoneal dialysis) and examining relevant medical issues specific to dialysis patients.
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Chest x rays (CXRs) are among the most difficult radiographs to interpret accurately. The aim of this study was to assess the ability of different grades and specialities of clinicians to evaluate a series of CXRs correctly. ⋯ To improve patient care, we suggest that all chest x rays should be reviewed at an early stage during a patient's hospital admission by a senior clinician and reported by a radiologist at the earliest opportunity. We also suggest that structured teaching on CXR interpretation should be made available for newly qualified doctors, especially with the introduction of shortened training.