QJM : monthly journal of the Association of Physicians
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Mild hyponatremia is the commonest electrolyte imbalance in the older population and has been shown to be associated with gait and attention deficits resulting in higher frequency of falls. The association of mild hyponatremia and bone fracture is still unknown. ⋯ Mild asymptomatic hyponatremia is associated with bone fracture in ambulatory elderly and avoiding iatrogenic hyponatremia or treating hyponatremia may decrease the number of bone fractures in this population.
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Randomized Controlled Trial Comparative Study
A randomised controlled trial of intramuscular vs. intravenous antivenom for latrodectism--the RAVE study.
Widow spider-bite causes latrodectism and is associated with significant morbidity worldwide. Antivenom is given by both the intravenous (IV) and intramuscular (IM) routes and it is unclear which is more effective. ⋯ The difference between IV and IM routes of administration of widow spider antivenom is, at best, small and does not justify routinely choosing one route over the other. Furthermore, antivenom may provide no benefit over placebo.
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The importance of acute medical units and their associated medical cover is stressed in current practice but there is a paucity of existing research to establish their impact on acute patient care. ⋯ The change in AMU process has resulted in improved DDR and patient length of stay, with no adverse effects on RR.
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To determine the impact of the introduction of an acute medical admission unit (AMAU) on all-cause hospital mortality in unselected patients undergoing acute medical admission to a teaching hospital. ⋯ The introduction of an AMAU significantly improved all-cause hospital mortality in acute unselected medical patients. The delivery of Acute Medicine may be enhanced by structural reform with emphasis on focus and volume. Prospective studies validating similar models elsewhere should be explored.
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To assess the clinical management of adults presenting with sudden, severe headache. ⋯ Patients with sudden, severe headache might benefit if EDs used simple protocols, emphasizing the crucial elements of history and examination, appropriate investigation and targeted consultation with neurologists.