QJM : monthly journal of the Association of Physicians
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There is interest in emergency medical admissions, the outcomes of major reconfigurations and the development of systems and processes for Acute Medicine. We report on the long-term outcomes of an Acute Medical Admissions Unit, using a database of emergency admissions to St James' Hospital, Dublin, from 2002 to 2012. ⋯ Institution reform can result in substantial outcome and process measure benefits, improving care delivery to emergency medical admissions.
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Comparative Study
Hemolysis and schistocytosis in the emergency department: consider pseudothrombotic microangiopathy related to vitamin B12 deficiency.
Hemolytic anemia with thrombocytopenia and schistocytosis is suggestive of thrombotic thrombocytopenic purpura (TTP). However, these features can occur in the context of vitamin B12 deficiency. ⋯ In a context of mechanical hemolysis with thrombocytopenia in a patient admitted to the emergency department, very high LDH levels and a low reticulocyte count are strongly suggestive of pseudo-TMA and should prompt the physician to screen for cobalamin deficiency.
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Older patients with chronic diseases often take multiple prescription drugs, increasing their risk of adverse health events. However, polypharmacy remains ill-defined. ⋯ The number of prescribed medications can be an index of PIM risk in older patients with chronic diseases. Clinicians should suspect high PIM risk in older outpatients with ≥ 5 prescriptions.
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Cancer-related pain is a common clinical problem, experienced by ∼90% of patients with cancer. The mainstay of treatment remains opioids and the WHO analgesic ladder. ⋯ The focus of this article is the mismatch between the temporal characteristics of the majority of cancer-related breakthrough pain which is fast onset and resolution, with the pharmacological profile of oral morphine. The contribution of fast-acting fentanyl preparations to the treatment of breakthrough pain and the evidence for the various commercially available preparations will be considered.