QJM : monthly journal of the Association of Physicians
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The symptoms and signs of heart failure can occur in the setting of an increased cardiac output and has been termed 'high output heart failure'. An elevated cardiac output with clinical heart failure is associated with several diseases including chronic anaemia, systemic arterio-venous fistulae, sepsis, hypercapnia and hyperthyroidism. The underlying primary physiological problem is of reduced systemic vascular resistance either due to arterio-venous shunting or peripheral vasodilatation. ⋯ The condition, although uncommon, is often associated with a potentially correctable aetiology. In the absence of a remediable cause, therapeutic options are very limited but include dietary restriction of salt and water combined with judicious use of diuretics. Vasodilators and beta-adrenoceptor positive inotropes are not recommended.
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Multicenter Study Comparative Study
Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison.
There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors' subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy. ⋯ Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety.
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Chronic disorders constitute a primary concern because of their burden on healthcare systems worldwide. Integrated care strategies enhancing the interface between tertiary care and primary care are pivotal to improve chronic care. ⋯ The study shows a high impact of cancer on planned hospitalizations whereas cardiovascular diseases and COPD generates a high percentage of unscheduled admissions. We conclude that integrated care services including patient-oriented guidelines are strongly needed to enhance both health and managerial outcomes.
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The following case of a young mother presenting with post-partum pulmonary oedema, highlights a singular and life-threatening complication of a common condition (thyrotoxicosis). While thyrotoxic heart disease is well described, thyrotoxic storm in the post-partum period associated with dilated cardiomyopathy, congestive cardiac failure and ventricular fibrillation is exceptional.
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Patients with diabetes have increased frequency of hospital admissions and longer lengths of stay compared to patients without diabetes. Our specialist diabetes inpatient service was reconfigured to deliver a proactive diabetes outreach service to improve the overall care of this population. ⋯ This reformatted service was associated with a marked improvement in a number of parameters relevant to inpatient care.