Clin Med
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Pulmonary embolism (PE) continues to be associated with significant mortality despite advances in the diagnostic techniques available for its detection. Anticoagulation remains standard treatment in PE although there is a consensus view that 'step-up' to thrombolytic therapy in addition to anticoagulation is indicated in those patients who are systemically shocked at presentation--a group defined as having suffered 'massive pulmonary embolism'. ⋯ In particular, the potential benefit of extending thrombolytic therapy to include those patients with sub-massive PE has been the subject of much enquiry and debate. This review examines the evidence for thrombolytic therapy and explores the potential for risk stratification in PE.
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Implementing national guidance such as that produced by the National Institute for Health and Clinical Excellence should be a priority for NHS trusts. The best way of managing successful implementation is through collaboration across the healthcare community. This helps to improve communication, ensures progress is being made and enables healthcare professionals to concentrate on the whole pathway of care, not just specific aspects of it. The Sheffield Parkinson's Stakeholder Group has successfully engaged all who are involved with providing the service across the city and has also received national recognition for its approach to implementation.
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Recent developments in the field of diabetes and endocrinology have led to greater understanding of the body's complex hormonal axes. This article reviews the latest significant treatments which have the potential to impact greatly on a wide variety of disease states in the not too distant future.
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Discounting of alcoholic products is universal in U. K. supermarkets with some chains selling own brand spirits for less than the duty payable per item. ⋯ In this article it is shown that families in Britain have nothing to fear from the introduction of a 50 p/unit minimum price of alcohol as the overall effect should be a reduction in average weekly supermarket bills for the majority while harmful and hazardous drinkers will pay more. By paying less for non-alcoholic products sold by supermarkets, moderate drinkers should no longer be effectively subsidising the alcohol purchased by the harmful and hazardous group.
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It is a concern that increasing pressure to diagnose, treat and discharge patients rapidly is leading to unacceptably high readmission rates. Readmissions were studied over a two-month period. Patients were identified through the hospital coding system, and electronic discharge summaries provided details of each admission. ⋯ Readmission is more likely in older patients with complex care needs. Rapid throughput of patients is not associated with readmission. The majority of readmissions can potentially be avoided with judicious medical care.