British medical bulletin
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In 1900, the population was beset with poverty, and infectious and deficiency diseases were common. The first half of the century was blighted by world wars, economic depression and post-war austerity. ⋯ The impact on food processing was manifold: nascent technologies such as freezing and chilling were increasingly exploited, and the consumer became the major focus of a food industry that became more sophisticated, embracing automation, computerisation and new developments in, for example, drying, heat processing, controlled and modified atmosphere packaging, ingredients and quality assurance. By 1999, this had led to an industry which provided foods that were not only safe, nutritious and palatable, but which were also increasingly convenient and healthy.
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Acute stroke treatment using aspirin and/or heparin was studied in the International Stroke Trial (IST) and Chinese Acute Stroke Trial (CAST) which randomised over 40,000 patients altogether. Combining the results demonstrated that aspirin (150-300 mg) given within 48 h of the onset of stroke produced a small but significant improvement in outcome (death or dependency) 4 weeks to 6 months after stroke of about 1 patient per 100 treated. There was a significant reduction in recurrent ischaemic stroke of similar degree, which was not associated with significant increase in cerebral haemorrhage. ⋯ Low molecular weight heparins and heparinoids have not proved any more beneficial. Therefore, heparin does not appear to be a useful routine therapy in acute stroke. The use of heparin should, therefore, be limited to patients at high risk of deep vein thrombosis or early recurrence.
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Sedation is a process of soothing. The concept of the ideal level of sedation is controversial and has changed over the last decade. ⋯ This change in attitude has been brought about by sophisticated modes of ventilation allowing the ventilator to synchronize with the patient's own breathing pattern. In addition, the increasingly recognised adverse effects of over-sedation have contributed to the reduction in the depth of sedation.
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British medical bulletin · Jan 1999
ReviewVentilatory support in the acute respiratory distress syndrome.
Ventilatory support in the acute respiratory distress syndrome (ARDS) has undergone considerable transformation in the 1990s. Current approaches include lung protective techniques which, while attempting to recruit and maintain lung volume, limit the shear stresses associated with ventilation by avoiding both alveolar overdistension and cyclical end-expiratory collapse. ⋯ Assessment of the inspiratory volume-pressure (V-P) curve provides information which can direct ventilator settings. Recent information from clinical trials has provided new insights into appropriate ventilatory modification and set the foundation for future clinical investigations.
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The majority of patients with polytrauma seen in the UK are victims of blunt injury. The trauma reception team approach, using a predetermined plan for initial assessment and urgent resuscitation, can improve outcome. It is important, therefore, that each member of the team is familiar with both their own role and that of their colleagues. ⋯ Accurate assessment of shock in the victim of trauma is difficult, as the simple clinical indicators are not ideal. Some of the techniques available for advanced assessment of tissue perfusion are discussed in detail. The management of polytrauma provides a considerable clinical challenge, and this chapter emphasises the importance of a team approach.