Internal medicine journal
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Internal medicine journal · Dec 2011
Comparative StudyUtilisation of emergency medical service among Singapore patients presenting with ST-segment elevation myocardial infarction: prevalence and impact on ischaemic time.
Previous studies in Western countries found that the emergency medical service (EMS) was under-used in patients with myocardial infarction. ⋯ Despite the availability of a centralised EMS, 64.7% of patients with STEMI did not contact EMS at presentation. These patients were less likely to receive primary PCI and had a significantly longer symptom-to-balloon time.
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Both chronic kidney disease (CKD) and end-stage renal disease are strongly age related. Although the morbidity and mortality of CKD have significantly improved in recent years because of a greater understanding of its pathophysiology and evidence-based approach to management, the application of this evidence to the elderly CKD patients is often fraught with difficulty. ⋯ This paper reviews the current evidence with a view to providing a framework for diagnosing and managing CKD in the elderly. Special references are made to age-related physiological changes in the renal system, assessment of renal function, and management of metabolic complications and end-stage renal disease.
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Internal medicine journal · Nov 2011
Systematic screening for occult cancer in elderly patients with venous thromboembolism: a prospective study.
Cancer is an established risk factor for venous thromboembolism (VTE) and the incidence of cancer increases in the elderly. The benefit of screening for occult cancers in this population is still not clear. ⋯ In this study of elderly patients, a non-invasive screening strategy did not detect several cancers that were subsequently overt clinically. A full history, clinical examination and routine laboratory investigations might be the optimal first-line strategy to detect cancer after the diagnosis of VTE in elderly patients, but regular clinical examinations during follow up are warranted.