Clin Med
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On 23 March 2014, the World Health Organization confirmed an outbreak of Ebola virus disease in Guinea. By August 2014, a delayed international response resulted in an unprecedented humanitarian emergency occurring in Guinea, Liberia and Sierra Leone. ⋯ Médecins Sans Frontières led the emergency response on the ground treating over 5,000 confirmed cases of Ebola. This article reflects on challenges faced working in an Ebola treatment centre and what future research may offer.
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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.
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Pruritus (itch) is a common complication of cholestatic liver diseases (CLD). It can be a distressing and debilitating symptom, causing significant impairment in quality of life. Treatment of pruritus in liver diseases can be challenging and requires specific management with early initiation and a step-wise approach using specific drugs. ⋯ Patients with cholestatic pruritus are likely to present to a variety of clinicians who would benefit from medical awareness of available treatment options. In this review, we outline the pharmaceutical agents currently used to treat cholestatic pruritus and provide the evidence base for targeted symptom control of itch in liver diseases. We also highlight recent developments in the pathophysiology of cholestatic pruritus and the emerging novel therapies.
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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.
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There have been a number of developments in the management of venous thromboembolism over the past few years. Old questions, such as thrombolysis, have been revisited in recent trials. New initiatives, such as ambulatory care pathways, are being established across the country. This conference brought together doctors from the UK, USA, Spain and Australia to review the up-to-date management of venous thromboembolism.