Clinical medicine (London, England)
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QRS electrical alternans is characterised by alternating amplitude of the QRS complexes, and is well-documented in cardiac conditions such as pericardial effusion. We describe a case of QRS alternans in a patient with gastric volvulus.
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The frailty syndrome is defined as a decrease in physiological reserve across multiple organ systems leading to increased vulnerability to external stressors. Studies across surgical subspecialties and in emergency and elective settings have identified frailty as an independent predictor of adverse postoperative clinician-reported, patient-reported and process-related outcomes. ⋯ Multiple tools to screen and diagnose frailty exist with limited appraisal of clinometric properties. A pragmatic approach to these tools is advocated with a future focus on collaborative approaches to modify the syndrome using multicomponent methodology such as comprehensive geriatric assessment and adapt the pathway to the needs of the frail surgical patient.
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Decisions on how and when to treat an abdominal aortic aneurysm involve a number of clinicians; interventional radiologists and vascular surgeons assess the technical ability to repair the aneurysm. Patients' fitness and past medical history is assessed to estimate their short- and long-term survival with or without surgery. Most importantly the patients' personal preference for treatment must be identified. Getting a patient to share what matters most to them requires shared decision making.
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Mortality from chronic kidney disease (CKD) is increasing. Most patients die from cardiovascular disease and management of cardiovascular risks is key to prevent both mortality and progression to end-stage renal disease. In 2014, the National Institute of Health and Care Excellence (NICE) introduced guidance to help general practitioners (GPs) manage CKD patients. ⋯ Post NICE guidelines, GPs are better in optimising BP. Diabetes management and lifestyle modifications need further improvement.
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Perioperative medicine for older people undergoing surgery (POPS) services are gaining traction, in acknowledgment of the poorer outcomes experienced by older surgical patients. In response to the NHS' growing focus on scaling innovation, a logic model of the POPS service at Guy's and St Thomas' NHS Foundation Trust was developed to articulate a founding centre's experience. ⋯ This is a novel study within the field of perioperative medicine for older people, interlinking implementation science theory to achieve meaningful clinical results and describe the lessons learnt during the process. Future work will include validation of this logic model to facilitate national POPS scale-up.