QJM : monthly journal of the Association of Physicians
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Physicians involved in the care of medical inpatients, irrespective of their sub-specialty area, will be responsible for the management of a significant number of older adults with complex care needs and multiple co-morbidities. These patients are vulnerable to poor outcomes (including falls, institutionalization and death)--a vulnerability often linked with the term 'frail' or 'frailty'. Frailty is associated with advanced chronological age and chronic disease but is a separate construct. ⋯ We explore how falls, a common cause of morbidity and mortality in older patient groups, may be a manifestation of increasing frailty and argue that falls services should avoid the practice of pursuing a single-organ cause when there are likely to be several contributing factors at play. We also consider the impact of frailty on medication prescribing and discuss how individualized prescribing could reduce the risk of adverse drug reactions in at-risk older inpatients. While it can be frustrating for physicians to manage patients who do not fit well into disease-based diagnostic and management algorithms, understanding frailty has the potential to improve the clinical care of vulnerable older people in the hospital setting.
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Idiopathic pulmonary fibrosis (IPF) is a dreadful disease that lacks adequate therapy. A number of treatment trials have been performed and have utilized a variety of primary efficacy endpoints. ⋯ Clinically meaningful events such as hospitalization can also provide important efficacy information. The use of non-validated surrogate endpoints as primary outcome measures often leads to uncertainty when interpreting trial results.
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Snakebites in snake handlers are an important clinical problem that may differ to bites in the general population. ⋯ Bites in snake handlers remain a common, important problem involving a broad range of snakes. Neurotoxicity and myotoxicity are relatively common, consistent with the snakes involved. Venom anaphylaxis occured, despite previously being a poorly recognized problem in snake handlers. The incidence of SHSRs to antivenoms, including anaphylaxis, was not higher than that observed in non-snake handlers.
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Patients at risk of rapid deterioration and critical illness often have preceding changes in physiological parameters. Track and trigger systems, such as the Modified Early Warning Score (MEWS) used in the UK, have been demonstrated to have some utility in identifying these patients particularly among general medical and surgical patients. ⋯ The currently used track and trigger systems have poor discriminatory value in identifying Oncological patients at risk of deterioration. An adapted score more focused upon the key predictive physiological parameters in this population needs to be developed to produce a more effective tool.