Clin Med
-
Demand for intensive care is growing. There are no contemporaneous consensus guidelines on which patients should be referred to intensive care. Prognostic scoring systems predict survival, but are of limited use for individual patients. ⋯ We identified specific markers indicating a poor prognosis in each group, and also identified common risk factors predicting a high mortality across all groups. Multiple organ failure at the time of referral to intensive care predicts a very poor outcome. Physical factors indicating a limited functional capacity also predict high mortality, suggesting that frailty has a significant impact on intensive care outcome.
-
Radiotherapy is an effective treatment modality and an essential tool in the management of cancer. As the incidence of malignant disease rises it is inevitable that physicians will increasingly encounter patients who have presented acutely and require radiotherapy or with a complication from irradiation. This paper explores the basic principles of radiotherapy tailored to the perspective of the acute medical physician and how to manage acute complications. We also discuss the role of radiotherapy in the acutely ill patient and define the need for radiotherapy pathways to ensure that patients receive treatment in a timely manner.
-
Blood transfusion is widely used in the management of acute upper gastrointestinal haemorrhage (AUGIH). Trial data suggests that excessive transfusion may be detrimental, yet overtransfusion remains commonplace. This study reports the impact of introducing a simple cross-match policy in a district general hospital, which resulted in a substantial fall in the prevalence of overtransfusion (odds ratio 0.43; 95% confidence interval 0.19-0.98), with potential patient benefits in terms of rebleeding, and a reduction in the total blood transfused from 162 to 121 units per 100 patients with AUGIH. For the cost of blood alone, this corresponds to projected savings across the NHS in England in excess of £2 million per annum.
-
Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ≥15 headache days per month for ≥3 months, in which ≥8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. ⋯ There is a strong need to improve diagnosis and therapeutic treatment of chronic migraine. Primary care physicians, as well as hospital-based physicians, are integral to the identification and treatment of these patients. The latest epidemiological data, as well as treatment options for chronic migraine patients, are reviewed here.