International journal of clinical practice
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Dissecting aneurysms generally cause radiating back pain, chest pain, or symptoms caused by aortic insufficiency. Presentation solely with abdominal pain is rare. We report on a patient with dissecting thoracic aortic aneurysm who presented solely with abdominal pain. The possibility of intrathoracic disease must be considered in every patient with abdominal pain, especially if the pain is in the upper part of the abdomen.
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Int. J. Clin. Pract. · Apr 1999
'Not for resuscitation': guidelines for decision making and documentation.
In 1991, the government's Chief Medical Officer made it clear that the responsibility for resuscitation policy lay with consultants, and that they should ensure this policy was understood by all staff caring for a patient, in particular junior medical staff. Since then, many hospitals and trusts have provided members of the multidisciplinary team with guidance on how to ensure that adequate and satisfactory communication is in place to record a patient's resuscitation status. ⋯ Guy's & St Thomas' Hospital Trust has been using a document since April 1998 which is clearly written, user friendly and does not contain ambiguous statements. With ongoing audit of this policy document we hope to reduce the incidence of inappropriate resuscitation attempts which are costly, both emotionally and financially, for all concerned.
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Int. J. Clin. Pract. · Apr 1999
Case ReportsAcute pulmonary oedema complicating adenotonsillectomy for obstructive sleep apnoea.
Acute pulmonary oedema can sometimes complicate adenotonsillectomy carried out for obstructive sleep apnoea. Early recognition and adequate oxygenation are the key to management. We report such a case; the pathophysiology and management of this rare complication of a common procedure are discussed.
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Int. J. Clin. Pract. · Mar 1999
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialThe incidence of cough: a comparison of lisinopril, placebo and telmisartan, a novel angiotensin II antagonist. Telmisartan Cough Study Group.
Dry cough is a troublesome side-effect associated with certain antihypertensive agents that act by modulating aspects of the renin-angiotensin-aldosterone system. The incidence of dry cough associated with two of these therapies, the novel All receptor antagonist telmisartan and the ACE inhibitor lisinopril, was assessed in a multicentre, randomised, parallel-group, double-blind, placebo-controlled, 8-week study of 88 patients with mild to moderate hypertension who previously demonstrated ACE inhibitor-related cough. ⋯ A visual analogue scale demonstrated a similar trend for cough frequency. Thus the incidence of cough with telmisartan 80 mg is significantly less than that seen with lisinopril 20 mg and is comparable to placebo.
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Int. J. Clin. Pract. · Jan 1999
Handling and acceptability of the Easi-Breathe device compared with a conventional metered dose inhaler by patients and practice nurses.
This study compared the handling and acceptability of the Easi-Breathe, a breath-actuated metered dose inhaler (MDI), with that of a conventional MDI. A total of 104 patients and 14 practice nurses took part in interviews at a central location. An additional 100 practice nurses were interviewed in a telephone study. ⋯ Overall, more patients preferred Easi-Breathe (82% vs 18%; p < or = 0.001), ease of use and confidence in successful dose delivery being the main reasons for their preference. Nurses thought that Easi-Breathe was easier for the vast majority of patients (97%) to use correctly, as well as being easier to teach and to use correctly in a crisis (p < or = 0.001). Overall, 79% of nurses preferred the Easi-Breathe to the conventional MDI (p < or = 0.001), ease of use and ease of teaching being the main reasons for their preference.