QJM : monthly journal of the Association of Physicians
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Comparative Study
Buying 'legal' recreational drugs does not mean that you are not breaking the law.
Recreational drug use in the UK is common; sources of recreational drugs are changing, with increasing purchase of legal highs from the Internet. Previous studies have shown that there is not consistency of active ingredient(s) in legal highs purchased from the Internet. ⋯ We have shown in this study that some drugs sold as 'legal' highs contain drugs that are controlled under the Misuse of Drugs Act (1971). Under current UK legislation, individuals purchasing legal highs that contained controlled drugs would be subject to the same penalties as if they had knowingly purchased a controlled drug. Dissemination of information on the harm associated with the use of legal highs should also inform individuals that they may be purchasing controlled substances and the potential legal consequences of this.
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Non-invasive ventilation (NIV) has revolutionized the management of hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD). However, most published data have evaluated highly selected patients within the context of randomized controlled trials. ⋯ In hypercapnic exacerbations of COPD, ward-based NIV is useful in the 'real-life' setting with physiological parameters improving after only a short treatment period, while two-thirds of all patients were discharged from hospital. Further data are required to help determine factors other than pH which influence the outcome of NIV.
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Review
Inhaled corticosteroids and risk of pneumonia: evidence for and against the proposed association.
Inhaled corticosteroids (ICS) are commonly used in the treatment of chronic obstructive pulmonary disease. Recent large prospective trials have reported an increased incidence of pneumonia in patients treated with ICS. Despite this, the link between ICS and pneumonia remains controversial. In this review, pro and con arguments for the association between ICS and increased pneumonia risk are discussed, drawing on evidence from experimental and clinical research.
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Advances in oncological care have led to improved short- and long-term prognosis of cancer patients but admission to the intensive care unit (ICU) remains controversial. ⋯ Short-term outcome of critically ill cancer patients in ICU is better than previously reported. The decision to admit cancer patients to ICU should depend on the severity of the acute illness rather than factors related to the malignancy. In appropriate patients, invasive organ support and re-admission should not be withheld.