Brit J Hosp Med
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In 2021 the Royal College of Emergency Medicine and the Faculty of Intensive Care Medicine collaborated to launch the 'Better together' framework to improve outcomes for critically unwell patients in the resuscitation room. One year on from the launch, it remains more relevant than ever.
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Acute myeloid leukaemia is a rare cancer, with about 3000 cases diagnosed each year in the UK. Diagnosis is based on patient history, blood and bone marrow tests and, in some cases, imaging. Chemotherapy is the mainstay of treatment for acute myeloid leukaemia, with eligible patients also undergoing allogeneic haematopoietic stem cell transplantation, which can be curative. ⋯ Improvements in transplant technology have increased donor availability and reduced transplant toxicity. At the same time, greater understanding of the cytogenetics and molecular genetics of acute myeloid leukaemia have helped to ensure that patients receive treatment that gives them the best chance of survival. A recent roundtable discussion considered how current diagnostic and treatment pathways might be adapted or enhanced to leverage good outcomes for the greatest numbers of patients.
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Anaemia affects a third of surgical patients and is associated with increased morbidity and mortality. Iron deficiency is the most common cause of anaemia and can be absolute or functional. Patients may require treatment with oral or intravenous iron.
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The current diagnosis of acute kidney injury relies on the measurement of serum creatinine levels and urine output. However, both measures are subject to considerable limitations; for example, change in serum creatinine levels ideally requires a knowledge of baseline function that is often not available. Furthermore, creatinine levels are influenced by many factors including diet, drug therapy, muscle mass, gender and ethnicity, which may lead to underestimation of the extent of renal dysfunction. ⋯ Many studies have focused on the identification of candidate molecules that may enable the early detection of individuals at risk of developing acute kidney injury, including constitutive proteins associated with kidney damage, as well as molecules upregulated in response to injury, non-renal products that may be filtered, reabsorbed or secreted by the kidney, and markers of renal stress. Such biomarkers may also aid stratification for adverse events, such as the need for kidney replacement therapy or progression to chronic kidney disease and end-stage kidney disease. This article discusses some of these novel biomarkers and assesses the role they may have in the understanding, management, diagnosis and prognostication of acute kidney injury.