MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Postgraduate Medical Journal' source. Fri, 19 Mar 2010 15:41:01 +0100 http://www.medworm.com/index.php?rid=3371837&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F192-b%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371837 Wed, 17 Mar 2010 12:07:51 +0100 3371837 http://www.medworm.com/index.php?rid=3371836&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F192-a%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371836 Wed, 17 Mar 2010 12:07:51 +0100 3371836 http://www.medworm.com/index.php?rid=3371835&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F191%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371835 Wed, 17 Mar 2010 12:07:51 +0100 3371835 http://www.medworm.com/index.php?rid=3371834&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F190%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371834 Wed, 17 Mar 2010 12:07:51 +0100 3371834 http://www.medworm.com/index.php?rid=3371833&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F189%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371833 Wed, 17 Mar 2010 12:07:51 +0100 3371833 http://www.medworm.com/index.php?rid=3371832&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F183%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371832 Wed, 17 Mar 2010 12:07:51 +0100 3371832 http://www.medworm.com/index.php?rid=3371831&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F174%3Frss%3D1 Integrated positron emission tomography/CT (PET/CT) with 2-[18F]fluoro-2-deoxy-d-glucose (FDG) is a hybrid imaging modality which has recently become established in the staging, restaging and therapy response assessment of oncology patients. FDG PET/CT has several recognised applications in colorectal cancer (CRC) imaging including preoperative evaluation of apparently limited metastatic disease, detection of disease recurrence, clarification of equivocal lesions at initial staging, investigation of unexplained rising tumour markers, and incidental detection of occult primary colonic tumours. With a constantly advancing body of evidence and increasing availability, applications of PET/CT in CRC are likely to emerge in therapy response assessment, radiotherapy planning, use of novel tracers... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371831 Wed, 17 Mar 2010 12:07:51 +0100 3371831 http://www.medworm.com/index.php?rid=3371830&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F165%3Frss%3D1 Cardiac CT involves acquisition of high-quality ECG-gated dynamic images of the heart. ECG gating allows exquisite delineation of the coronary arteries, which are subjected to respiratory and cardiac motion. Cardiac CT has an established role in the assessment of coronary artery disease in selected patient groups and permits detailed assessment of cardiac and great vessel anatomy. The technique can also be used for a number of non-coronary applications including assessment of the pericardium, cardiac tumours and pulmonary veins. In this article, these applications are reviewed and the salient imaging findings across a range of structural cardiac disease illustrated. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371830 Wed, 17 Mar 2010 12:07:51 +0100 3371830 http://www.medworm.com/index.php?rid=3371829&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F160%3Frss%3D1 Pregnancy is a time of great maternal physiological and metabolic changes. This affects the biochemical and haematological parameters used in the assessment of liver disease, and it is important to appreciate the different reference ranges in pregnancy to facilitate recognition of liver disorders in pregnancy. Due to the increased physiological and metabolic stress of pregnancy, liver disorders that have previously been subclinical may become symptomatic—for example, primary biliary cirrhosis. Gallstone disease is a common problem in women of childbearing age, and pregnancy promotes their formation. The viral hepatidides constitute a huge disease burden worldwide and the pregnant state confers particular concerns for the mother and her baby. In particular, hepatitis E has a predilect... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371829 Wed, 17 Mar 2010 12:07:51 +0100 3371829 http://www.medworm.com/index.php?rid=3371828&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F153%3Frss%3D1 Neuromyelitis optica (NMO) is a relapsing inflammatory disorder of the central nervous system that closely resembles multiple sclerosis. This review discusses recent understanding of NMO with reference to epidemiology, clinical spectrum, immunopathology, diagnostic evaluation, clinical course and management. Within the clinical spectrum of NMO, the classical form (with relapsing opticomyelitis) and limited forms (either recurrent myelitis or optic neuritis), as well as its association with other autoimmune disorders, have been recognised in recent years. Further, symptomatic or asymptomatic cerebral lesions may be present, and such brain lesions do not necessarily exclude the diagnosis. In the appropriate clinical context, the diagnosis is supported by longitudinally extensive myelitis on ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371828 Wed, 17 Mar 2010 12:07:51 +0100 3371828 http://www.medworm.com/index.php?rid=3371827&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F143%3Frss%3D1 Conclusions Pragmatic education on best practice for cause-of-death certification is a basic step to ensure accurate information for each individual case, leading to the production of high quality mortality statistics for epidemiology, public health policy and research. Development of new educational interventions or modification of existing programmes should be based on evidence of the benefits from current and past interventions provided under varying circumstances. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371827 Wed, 17 Mar 2010 12:07:51 +0100 3371827 http://www.medworm.com/index.php?rid=3371826&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F136%3Frss%3D1 The risk of hyperkalaemia in patients with heart failure has increased in the past few years together with the evolution of pharmacological treatment for these patients. This significant change has been associated with the introduction of angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and aldosterone antagonists. High potassium concentrations in heart failure could lead to life threatening events, and therefore should be taken seriously. In this review we summarise the information about potassium homeostasis in heart failure and the current risk of developing potentially serious hyperkalaemia, particularly in association with the use of aldosterone antagonists. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371826 Wed, 17 Mar 2010 12:07:51 +0100 3371826 http://www.medworm.com/index.php?rid=3371825&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F131%3Frss%3D1 Conclusion Survival rates in nursing home residents admitted to an acute medical unit are low, and measures are suggested to reduce inappropriate admissions and facilitate improved end of life care. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371825 Wed, 17 Mar 2010 12:07:51 +0100 3371825 http://www.medworm.com/index.php?rid=3371824&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1013%2F129%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3371824 Wed, 17 Mar 2010 12:07:51 +0100 3371824 http://www.medworm.com/index.php?rid=3256716&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F128-b%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256716 Tue, 09 Feb 2010 15:47:21 +0100 3256716 http://www.medworm.com/index.php?rid=3256715&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F128-a%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256715 Tue, 09 Feb 2010 15:47:21 +0100 3256715 http://www.medworm.com/index.php?rid=3256714&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F127%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256714 Tue, 09 Feb 2010 15:47:21 +0100 3256714 http://www.medworm.com/index.php?rid=3256713&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F123%3Frss%3D1 This study aims at evaluating doctors' attitudes towards handling medical errors made by their peers. Materials This cross-sectional questionnaire survey was conducted between April and July 2006 and targeted general practitioners attending continuing medical education programmes in Tehran. A total of 474 doctors were approached, 400 of whom completed the questionnaire. The questionnaire contained a clinical vignette with three hypothetical patient outcomes: near-miss, leading to harm, and leading to death. The participants were asked how they would deal with each case. They were also asked how they would prefer their peers to react when they themselves made a medical error. Results The most common attitude toward peers' medical errors was reporting it to the original doctor and asking t... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256713 Tue, 09 Feb 2010 15:47:21 +0100 3256713 http://www.medworm.com/index.php?rid=3256712&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F116%3Frss%3D1 Patients with non-ischaemic dilated cardiomyopathy (NICM) are at significant risk of sudden cardiac death. Multiple randomised trials have shown that implantable cardioverter defibrillators (ICDs) reduce mortality in high-risk patients with NICM. However, despite this, the National Institute for Health and Clinical Excellence specifically excluded patients with NICM from its updated guidance concerning ICD use. This lack of guidance poses clear problems for both clinicians managing patients with NICM and those who commission healthcare services. This review aims to help guide clinicians in this difficult, high-cost and high-risk area. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256712 Tue, 09 Feb 2010 15:47:21 +0100 3256712 http://www.medworm.com/index.php?rid=3256711&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F106%3Frss%3D1 Staging for non-small cell lung cancer (NSCLC) requires accurate assessment of the mediastinal lymph nodes which determines treatment and outcome. As radiological staging is limited by its specificity and sensitivity, it is necessary to sample the mediastinal nodes. Traditionally, mediastinoscopy has been used for evaluation of the mediastinum especially when radical treatment is contemplated, although conventional transbronchial needle aspiration (TBNA) has also been used in other situations for staging and diagnostic purposes. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive alternative to mediastinoscopy with additional access to the hilar nodes, a better safety profile, and it removes the costs and hazards of theatre time and gene... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256711 Tue, 09 Feb 2010 15:47:21 +0100 3256711 http://www.medworm.com/index.php?rid=3256710&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F100%3Frss%3D1 This article reviews the management of women with heart disease during pregnancy, labour and in the puerperium. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256710 Tue, 09 Feb 2010 15:47:21 +0100 3256710 http://www.medworm.com/index.php?rid=3256709&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F94%3Frss%3D1 Immune dysregulation has become a hallmark of the modern era. This has led to an epidemic of disease states that result from failed immune surveillance and inappropriate or maladaptive immune responses to self-antigens (autoimmunity) and environmental antigens (allergy). Although environmental change is clearly implicated, the specific causes are still unconfirmed. Any hope to reverse such immune dysfunction must be based on a clearer understanding of the causal pathways and the environmental factors that may be driving the concerning surge in disease rates. This review explores the role of modern dietary changes that, through their known documented immune effects, may play a role in either promoting or preventing disease. Food allergen avoidance has been largely unsuccessful, and most exp... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256709 Tue, 09 Feb 2010 15:47:21 +0100 3256709 http://www.medworm.com/index.php?rid=3256708&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F89%3Frss%3D1 Problem The need to improve the prescription, administration and monitoring of oxygen therapy. Design An interventional, prospective audit. Background and setting Wellington Hospital, a teaching and tertiary referral hospital in New Zealand in 2007 and 2008. Key measures for improvement Demonstration of adequate oxygen prescribing, administration and monitoring of oxygen therapy. Strategies for improvement The introduction of a new drug chart with a specific oxygen prescription section. Targeted educational lectures primarily to medical staff. Effects of change 610 and 566 patients were reviewed in the first and second audits. After introduction of the new oxygen prescription section on the drug chart the proportion of patients whose oxygen therapy was prescribed increased from 15/85 ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256708 Tue, 09 Feb 2010 15:47:21 +0100 3256708 http://www.medworm.com/index.php?rid=3256707&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F83%3Frss%3D1 Conclusion The incidence of SIRS was low in dermatological diseases. In this cohort, CADR was the most common cause of SIRS. Patients who developed sepsis or MODS had a poor outcome. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256707 Tue, 09 Feb 2010 15:47:21 +0100 3256707 http://www.medworm.com/index.php?rid=3256706&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F79%3Frss%3D1 Conclusions Monospecific anti-Ro52 reactivity is not disease specific but may be of importance in patients with IIM. Furthermore, as anti-Ro52 reactivity is more prevalent than anti-Ro60 reactivity in certain autoimmune conditions, specific testing for their distinction in clinical practice is recommended. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256706 Tue, 09 Feb 2010 15:47:21 +0100 3256706 http://www.medworm.com/index.php?rid=3256705&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F73%3Frss%3D1 Conclusions Administrative data provide a good estimate of the prevalence of most comorbid conditions but may be biased for some comorbid conditions that can be contra-indicators for cancer treatment. The time window in which a comorbid condition occurs in relation to the cancer diagnosis should be taken into account. Adjustment should be carried out, where possible, to provide more robust and clinically appropriate comparisons of population based cancer patient survival. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256705 Tue, 09 Feb 2010 15:47:21 +0100 3256705 http://www.medworm.com/index.php?rid=3256704&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F68%3Frss%3D1 Conclusions 67% of responding trusts had encountered major complications of ICD. The survey raised concerns about training and consent. The National Patient Safety Agency has made recommendations to address these risks which are also addressed in the 2009 update of the British Thoracic Society Pleural Disease Guideline. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256704 Tue, 09 Feb 2010 15:47:21 +0100 3256704 http://www.medworm.com/index.php?rid=3256703&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F66%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256703 Tue, 09 Feb 2010 15:47:21 +0100 3256703 http://www.medworm.com/index.php?rid=3256702&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1012%2F65%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3256702 Tue, 09 Feb 2010 15:47:21 +0100 3256702 http://www.medworm.com/index.php?rid=3161317&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F63%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161317 Mon, 11 Jan 2010 23:58:56 +0100 3161317 http://www.medworm.com/index.php?rid=3161316&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F62%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161316 Mon, 11 Jan 2010 23:58:56 +0100 3161316 http://www.medworm.com/index.php?rid=3161315&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F52%3Frss%3D1 This article provides a new, comprehensive overview of the pathology, diagnosis, evolution and management of patients with AAS. As acute aortic disease is the most common fatal condition in patients with chest pain, prompt recognition and treatment is of paramount importance. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161315 Mon, 11 Jan 2010 23:58:56 +0100 3161315 http://www.medworm.com/index.php?rid=3161314&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F42%3Frss%3D1 Improvements in magnetic resonance (MR) imaging now permit diagnostic images of the fetus to be obtained. Ultrasound remains vital in all aspects of fetal imaging but MR provides a useful second line imaging test. Its value is best researched in fetal central nervous system disorders but it can be applied in other areas too. This pictorial review shows many of the commonly encountered problems. The pictures have a powerful impact on parental understanding. Future research must involve determination of the prognosis of abnormalities found at MR. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161314 Mon, 11 Jan 2010 23:58:56 +0100 3161314 http://www.medworm.com/index.php?rid=3161313&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F34%3Frss%3D1 Hepatic encephalopathy is a common metabolic condition in children, having a significantly different aetiopathogenesis from that in adults. The present paper reviews the medical interventions of proven efficacy and also discusses recent advances from various fields as applicable to management of children with this disorder, focusing on measures other than liver transplant. The most important component of managing a child with hepatic encephalopathy is basic intensive care with regulation of fluid status, glucose and electrolyte homeostasis. Specific management includes measures to reduce serum ammonia concentrations, and the prevention and prompt treatment of complications. Methods to reduce ammonia target various steps in its metabolism. This includes reducing its production in and absorp... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161313 Mon, 11 Jan 2010 23:58:56 +0100 3161313 http://www.medworm.com/index.php?rid=3161312&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F26%3Frss%3D1 Smoking is the most important and preventable cause of morbidity and premature mortality in developed and developing countries. To date, efforts to reduce the burden of smoking have focused on non-personalised strategies. Anxiety about ill health, especially lung cancer and emphysema, is the foremost concern for smokers and a major reason for quitting. Recent efforts in cessation management focus on behaviour change and pharmacotherapy. The ‘3 Ts’ (tension, trigger, treatment) model of behaviour change proposes that at any one time a smoker experiences varying degrees of motivational tension, which in the presence of a trigger may initiate or enhance quitting. Smokers' optimistic bias (ie, denial of one's own vulnerability) sustains continued smoking, while increasing motivatio... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161312 Mon, 11 Jan 2010 23:58:56 +0100 3161312 http://www.medworm.com/index.php?rid=3161311&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F18%3Frss%3D1 This article reviews the evidence linking Vitamin D deficiency in the pathogenesis of type 2 diabetes, and suggests areas for urgent further research to determine whether Vitamin D replacement has a role in the prevention of type 2 diabetes. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161311 Mon, 11 Jan 2010 23:58:56 +0100 3161311 http://www.medworm.com/index.php?rid=3161310&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F12%3Frss%3D1 This article reviews the evidence for CRT, the current indications, and important information relevant to the clinician treating patients with heart failure. It also highlights some of the current controversies in this field as well as the need for future research. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161310 Mon, 11 Jan 2010 23:58:56 +0100 3161310 http://www.medworm.com/index.php?rid=3161309&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F8%3Frss%3D1 Conclusion There are many clinical indications for TUS but the most common is pleural effusion assessment. TUS can diagnose inoperable pleural metastases, allow safe day case pleural intervention, exclude significant pleural pathology not visible on CXR, and triage further investigation. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161309 Mon, 11 Jan 2010 23:58:56 +0100 3161309 http://www.medworm.com/index.php?rid=3161308&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F3%3Frss%3D1 Conclusions For low-risk patients, a nurse-led palpitations clinic may provide a viable alternative to the traditional cardiology outpatient service. Despite attempts to exclude them, some high-risk patients were seen. This was unforeseen and led to a clinically important delay in their appropriate assessment. Hence, before adopting a nurse-led palpitations service, a rigorous pathway for the early assessment of high-risk patients needs to be agreed. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161308 Mon, 11 Jan 2010 23:58:56 +0100 3161308 http://www.medworm.com/index.php?rid=3161307&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F86%2F1011%2F1%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=3161307 Mon, 11 Jan 2010 23:58:56 +0100 3161307 http://www.medworm.com/index.php?rid=2965207&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F631%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965207 Thu, 05 Nov 2009 18:01:51 +0100 2965207 http://www.medworm.com/index.php?rid=2965206&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F622%3Frss%3D1 Duchenne muscular dystrophy (DMD), Becker muscular dystrophy (BMD) and limb girdle muscular dystrophies (LGMD) represent a significant proportion of paediatric and adult neuromuscular neurology practice. The proactive symptom-based multidisciplinary team (MDT) management and access to non-invasive ventilation have enabled improved survival into adulthood. Nevertheless the severe disability imposed by conditions such as DMD poses a challenge for successful transition of care and management for paediatric and adult neurology teams. DMD is discussed in detail as a paradigm illustrating diagnosis, management and role for different pharmacological interventions to improve survival, but also challenges in adulthood care, and cutting-edge therapies. LGMDs are much rarer than DMD and BMD, and in a... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965206 Thu, 05 Nov 2009 18:01:51 +0100 2965206 http://www.medworm.com/index.php?rid=2965205&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F614%3Frss%3D1 The metabolic syndrome (MetS) represents a combination of cardiometabolic risk determinants including obesity (central adiposity), insulin resistance, glucose intolerance, dyslipidaemia, non-alcoholic fatty liver disease and hypertension. MetS is rapidly increasing in prevalence worldwide as a consequence of the continued obesity "epidemic", and as a result will have a considerable impact on the global incidence of cardiovascular disease and type 2 diabetes. Currently, there is debate concerning whether the risk of cardiovascular disease is greater in patients diagnosed with MetS than that of the sum of the individual risk factors. At present, no unifying origin that can explain the pathogenesis of MetS has been identified and therefore no unique pharmacological treatment is available. Thi... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965205 Thu, 05 Nov 2009 18:01:51 +0100 2965205 http://www.medworm.com/index.php?rid=2965204&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F606%3Frss%3D1 The emergence of hybrid imaging, combining anatomical computed tomography (CT) and functional scintigraphic imaging has increased the armoury of techniques available to image disease. Single photon emission computed tomography/CT (SPECT/CT) is a dual modality technique which increases the sensitivity and specificity of existing radionuclide imaging and helps characterise equivocal lesions detected by other imaging methods. In addition to the many established clinical applications for SPECT/CT, there are new clinical uses emerging in a spectrum of benign and malignant diseases. In this article, we will discuss the established and emerging uses of hybrid SPECT/CT and illustrate the incremental value of the technique in a variety of clinical applications. (Source: Postgraduate Medical Journal... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965204 Thu, 05 Nov 2009 18:01:51 +0100 2965204 http://www.medworm.com/index.php?rid=2965203&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F597%3Frss%3D1 Imaging of patients with hyperparathyroidism has evolved over the last decade and transformed surgical management of the disease. Traditional bilateral neck dissection and exploratory surgery has been overtaken by focused, minimally invasive procedures in patients with single-gland disease. Accurate preoperative localisation of the involved parathyroid gland is the cornerstone for success of the new surgical techniques. In this article, the strengths, limitations and respective roles of different imaging modalities used to evaluate patients with hyperparathyroidism will be reviewed. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965203 Thu, 05 Nov 2009 18:01:51 +0100 2965203 http://www.medworm.com/index.php?rid=2965202&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F590%3Frss%3D1 Impulse control disorders (ICDs) are a heterogeneous group of conditions involving repetitive, excessive and compulsive activities that interfere with life functioning. Examples are pathological gambling, compulsive shopping and hypersexuality. Over the last decade, ICDs have become increasingly recognised as being associated with Parkinson disease (PD), with the literature highlighting a link between dopamine replacement therapy and the development of ICDs. Patients who develop ICDs in the context of compulsive anti-Parkinsonian drug use are described as having dopamine dysregulation syndrome (DDS), which is associated with repetitive complex stereotyped behaviours called punding. Case–control and observational studies have further noted that patients with PD who develop ICDs are mo... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965202 Thu, 05 Nov 2009 18:01:51 +0100 2965202 http://www.medworm.com/index.php?rid=2965201&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F582%3Frss%3D1 Conclusions: Overall, F1s in the study were not well prepared either to perform the tasks that await them or in terms of most of the specific background knowledge and skills necessary for the successful execution of those tasks. The level of preparedness raises important issues about medical training and transition from medical graduate to first year doctor. Further research is needed to determine whether this situation exists in other regions of the UK. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965201 Thu, 05 Nov 2009 18:01:51 +0100 2965201 http://www.medworm.com/index.php?rid=2965200&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F573%3Frss%3D1 Conclusions: Zygomycosis is a threat in uncontrolled diabetes. New risk factors such as renal failure and chronic liver disease require attention. A elegans is an emerging agent in India. The need for surgical debridement in addition to medical treatment is emphasised. GCS is an independent marker of prognosis in cases of invasive zygomycosis. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965200 Thu, 05 Nov 2009 18:01:51 +0100 2965200 http://www.medworm.com/index.php?rid=2965199&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F572%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965199 Thu, 05 Nov 2009 18:01:51 +0100 2965199 http://www.medworm.com/index.php?rid=2965198&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F569%3Frss%3D1 There has been a dramatic change in the way that resuscitation decisions are made for older hospital inpatients in the UK. In less than 20 years many geriatric medicine wards have moved from an "opt-in" policy (where the default position is not to provide resuscitation) to a position where resuscitation is widely available to older patients and clinicians are much more reluctant to make "do not attempt cardiopulmonary resuscitation" decisions on medical grounds alone. The drivers for this change are rooted in societal changes rather than scientific or legal advances. Older patients are increasingly educated and have higher expectations of health care, while doctors are more commonly criticised and have progressively less "power" in the doctor–patient relationship. Doctors in the UK a... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965198 Thu, 05 Nov 2009 18:01:51 +0100 2965198 http://www.medworm.com/index.php?rid=2965197&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F564%3Frss%3D1 Conclusions: Doctors would benefit from greater support for their decision making in relation to resuscitation to reduce variability in clinical practice and to promote appropriate patient care. Identification of factors that influence doctors’ individual beliefs, attitudes and values towards resuscitation and improvement in the quality of patient communication may help to guide policy in this area. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965197 Thu, 05 Nov 2009 18:01:51 +0100 2965197 http://www.medworm.com/index.php?rid=2965196&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1009%2F561%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2965196 Thu, 05 Nov 2009 18:01:51 +0100 2965196 http://www.medworm.com/index.php?rid=2848649&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F560%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848649 Tue, 29 Sep 2009 12:31:07 +0100 2848649 http://www.medworm.com/index.php?rid=2848648&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F552%3Frss%3D1 Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients’ continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which reco... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848648 Tue, 29 Sep 2009 12:31:07 +0100 2848648 http://www.medworm.com/index.php?rid=2848647&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F546%3Frss%3D1 We describe the management of narrow complex arrhythmias likely to be encountered, including the ubiquitous atrial fibrillation. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848647 Tue, 29 Sep 2009 12:31:07 +0100 2848647 http://www.medworm.com/index.php?rid=2848646&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F538%3Frss%3D1 A biomarker is a characteristic that can be objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacological responses to a therapeutic intervention. Many commonly used tests in clinical practice can serve as biomarkers. The majority have been identified on the basis of insight or underlying physiology or biological mechanisms. With increasing knowledge and practical experience, some of these tests have evolved into a measurable end point in clinical research, applied as an indicator of change, for the better or worse. The traditional identification of biomarkers as an observational side product of clinical practice is increasingly turning into an industrialised process of biomarker discovery, supported by standardised paradigms of ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848646 Tue, 29 Sep 2009 12:31:07 +0100 2848646 http://www.medworm.com/index.php?rid=2848645&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F530%3Frss%3D1 Conclusion: A PBLI curriculum that is centred around practice-based quality improvement projects can fulfil the objectives of this ACGME competency while accomplishing sustained outcomes in quality improvement. A comprehensive curriculum is an investment but offers organisational rewards. We propose a more realistic and informative representation of rapid PDSA cycle changes. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848645 Tue, 29 Sep 2009 12:31:07 +0100 2848645 http://www.medworm.com/index.php?rid=2848644&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F525%3Frss%3D1 Conclusion: At a low dose regimen, dexamethasone was not effective in achieving a higher rise of platelet count in dengue infection. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848644 Tue, 29 Sep 2009 12:31:07 +0100 2848644 http://www.medworm.com/index.php?rid=2848643&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F515%3Frss%3D1 Conclusions: When numeric scores were assigned to both the SNP and demographic data, and sequentially combined by a simple algorithm in a risk model, the composite score was found to be linearly related to lung cancer risk with a bimodal distribution. Genetic data may therefore be combined with other risk variables from smokers or ex-smokers to identify individuals who are most susceptible to developing lung cancer. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848643 Tue, 29 Sep 2009 12:31:07 +0100 2848643 http://www.medworm.com/index.php?rid=2848642&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F514%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848642 Tue, 29 Sep 2009 12:31:07 +0100 2848642 http://www.medworm.com/index.php?rid=2848641&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F509%3Frss%3D1 Most mentally ill people in low and middle income countries, where clinical services are typically scarce and mental health legal provisions often inadequate, do not receive requisite evidence based treatment. The unfortunate consequence is compromised health and well-being and lack of social integration in the community. Recent initiatives, such as the Movement for Global Mental Health, aim to improve the situation and, in so doing, take into account ethical factors that play a role in the face of inadequate care and mental health legislative frameworks. Two composite case vignettes based on the narratives of actual patients living in India are used to show how family carers resort to measures like deception, coercion and physical restraint in order to deal with challenging behaviours ste... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848641 Tue, 29 Sep 2009 12:31:07 +0100 2848641 http://www.medworm.com/index.php?rid=2848640&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F507%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848640 Tue, 29 Sep 2009 12:31:07 +0100 2848640 http://www.medworm.com/index.php?rid=2848639&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F505%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2848639 Tue, 29 Sep 2009 12:31:07 +0100 2848639 http://www.medworm.com/index.php?rid=2840414&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F560%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840414 Mon, 28 Sep 2009 23:00:00 +0100 2840414 http://www.medworm.com/index.php?rid=2840413&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F552%3Frss%3D1 Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients’ continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which reco... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840413 Mon, 28 Sep 2009 23:00:00 +0100 2840413 http://www.medworm.com/index.php?rid=2840412&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F546%3Frss%3D1 We describe the management of narrow complex arrhythmias likely to be encountered, including the ubiquitous atrial fibrillation. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840412 Mon, 28 Sep 2009 23:00:00 +0100 2840412 http://www.medworm.com/index.php?rid=2840411&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F538%3Frss%3D1 A biomarker is a characteristic that can be objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacological responses to a therapeutic intervention. Many commonly used tests in clinical practice can serve as biomarkers. The majority have been identified on the basis of insight or underlying physiology or biological mechanisms. With increasing knowledge and practical experience, some of these tests have evolved into a measurable end point in clinical research, applied as an indicator of change, for the better or worse. The traditional identification of biomarkers as an observational side product of clinical practice is increasingly turning into an industrialised process of biomarker discovery, supported by standardised paradigms of ... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840411 Mon, 28 Sep 2009 23:00:00 +0100 2840411 http://www.medworm.com/index.php?rid=2840410&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F530%3Frss%3D1 Conclusion: A PBLI curriculum that is centred around practice-based quality improvement projects can fulfil the objectives of this ACGME competency while accomplishing sustained outcomes in quality improvement. A comprehensive curriculum is an investment but offers organisational rewards. We propose a more realistic and informative representation of rapid PDSA cycle changes. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840410 Mon, 28 Sep 2009 23:00:00 +0100 2840410 http://www.medworm.com/index.php?rid=2840409&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F525%3Frss%3D1 Conclusion: At a low dose regimen, dexamethasone was not effective in achieving a higher rise of platelet count in dengue infection. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840409 Mon, 28 Sep 2009 23:00:00 +0100 2840409 http://www.medworm.com/index.php?rid=2840408&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F515%3Frss%3D1 Conclusions: When numeric scores were assigned to both the SNP and demographic data, and sequentially combined by a simple algorithm in a risk model, the composite score was found to be linearly related to lung cancer risk with a bimodal distribution. Genetic data may therefore be combined with other risk variables from smokers or ex-smokers to identify individuals who are most susceptible to developing lung cancer. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840408 Mon, 28 Sep 2009 23:00:00 +0100 2840408 http://www.medworm.com/index.php?rid=2840407&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F514%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840407 Mon, 28 Sep 2009 23:00:00 +0100 2840407 http://www.medworm.com/index.php?rid=2840406&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F509%3Frss%3D1 Most mentally ill people in low and middle income countries, where clinical services are typically scarce and mental health legal provisions often inadequate, do not receive requisite evidence based treatment. The unfortunate consequence is compromised health and well-being and lack of social integration in the community. Recent initiatives, such as the Movement for Global Mental Health, aim to improve the situation and, in so doing, take into account ethical factors that play a role in the face of inadequate care and mental health legislative frameworks. Two composite case vignettes based on the narratives of actual patients living in India are used to show how family carers resort to measures like deception, coercion and physical restraint in order to deal with challenging behaviours ste... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840406 Mon, 28 Sep 2009 23:00:00 +0100 2840406 http://www.medworm.com/index.php?rid=2840405&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F507%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840405 Mon, 28 Sep 2009 23:00:00 +0100 2840405 http://www.medworm.com/index.php?rid=2840404&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1008%2F505%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2840404 Mon, 28 Sep 2009 23:00:00 +0100 2840404 http://www.medworm.com/index.php?rid=2767458&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F503%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767458 Thu, 03 Sep 2009 23:00:00 +0100 2767458 http://www.medworm.com/index.php?rid=2767457&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F501%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767457 Thu, 03 Sep 2009 23:00:00 +0100 2767457 http://www.medworm.com/index.php?rid=2767456&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F495%3Frss%3D1 Conclusions: Raised awareness of L-ORMD should lead to earlier diagnosis and improved care for patients. New antivascular endothelial growth factor treatment may provide a new possibility for management. A deeper insight into molecular and genetic mechanisms of L-ORMD may suggest avenues to explore new treatments of this disorder. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767456 Thu, 03 Sep 2009 23:00:00 +0100 2767456 http://www.medworm.com/index.php?rid=2767455&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F489%3Frss%3D1 This article provides an overview of the pathophysiology, diagnosis, treatment and prevention of VTE in pregnancy and refers the reader to recent evidence based guidelines. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767455 Thu, 03 Sep 2009 23:00:00 +0100 2767455 http://www.medworm.com/index.php?rid=2767454&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F481%3Frss%3D1 The treatment of cold injuries to the periphery has advanced substantially in the last 10 years and optimal outcomes are only likely to be achieved if a multidisciplinary team uses the full range of diagnostic and treatment modalities that are now available. The internet and satellite phones with digital images allow immediate access by patients from remote geographical locations to hospital based specialists who can assess cold injuries and advise on early field care. The severity of frostbite injuries can now be assessed with triple phase bone scanning, allowing early prediction of likely subsequent tissue loss. Early hyperbaric oxygen therapy appears to improve outcome and the use of intravenous drugs such as synthetic prostaglandin analogues infusions and tissue plasminogen activator h... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767454 Thu, 03 Sep 2009 23:00:00 +0100 2767454 http://www.medworm.com/index.php?rid=2767453&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F475%3Frss%3D1 This article highlights findings from diabetes prevention programmes and discusses key issues involved in translating research into practice. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767453 Thu, 03 Sep 2009 23:00:00 +0100 2767453 http://www.medworm.com/index.php?rid=2767452&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F470%3Frss%3D1 Conclusions: Infections, including septicaemia and pneumonia, are the leading causes of hospital mortality in our setting, followed by malignancy and cardiovascular causes. The overall mortality rate is comparable to published mortality data from other hospital settings. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767452 Thu, 03 Sep 2009 23:00:00 +0100 2767452 http://www.medworm.com/index.php?rid=2767451&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F464%3Frss%3D1 Conclusions: We developed and validated a risk score for the prediction of 3 year mortality. This risk score can be used to stratify patients into different risk categories, thereby informing patient counselling and tailored diagnostic and therapeutic decisions in clinical practice. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767451 Thu, 03 Sep 2009 23:00:00 +0100 2767451 http://www.medworm.com/index.php?rid=2767450&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F460%3Frss%3D1 Background: The use of verbal orders has been identified as a potential contributor to poor quality and less safe care. As a result, many organisations have encouraged changing the verbal orders process and/or reducing/eliminating verbal orders altogether (Joint Commission (2005), Institute of Medicine (2001), Leapfrog organisation, Institute of Safe Medication Practices). Ironically there is a paucity of research evidence to support the widespread concern over verbal order. Aims: This paper describes the very limited existing research on verbal orders, presents a model of verbal order use identifying potential error trigger points and suggests a verbal order research agenda in order to better understand the nature and extent of the potential patient care safety threat posed by verbal ord... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767450 Thu, 03 Sep 2009 23:00:00 +0100 2767450 http://www.medworm.com/index.php?rid=2767449&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F455%3Frss%3D1 Conclusions: Facebook is providing a readily accessible portal for patients, carers and healthcare professionals to share their experiences of investigation, diagnosis and management of disease. Furthermore, this technology is being used for research, education and fundraising. Further research is warranted to explore the further potential of this new technology. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767449 Thu, 03 Sep 2009 23:00:00 +0100 2767449 http://www.medworm.com/index.php?rid=2767448&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F451%3Frss%3D1 Conclusion: Despite a sharp increase in the absolute numbers of CECs across the UK, the number of cases considered by the majority of CECs is low. The findings presented here suggest we must reflect on the reasons for such low caseloads and pause to consider whether the committee model is most appropriate for the UK context. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767448 Thu, 03 Sep 2009 23:00:00 +0100 2767448 http://www.medworm.com/index.php?rid=2767447&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1007%2F449%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2767447 Thu, 03 Sep 2009 23:00:00 +0100 2767447 http://www.medworm.com/index.php?rid=2632347&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F447%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632347 Wed, 22 Jul 2009 23:00:00 +0100 2632347 http://www.medworm.com/index.php?rid=2632346&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F437%3Frss%3D1 The inflammatory neuropathies are a large diverse group of immune-mediated neuropathies that are amenable to treatment and may be reversible. Their accurate diagnosis is essential for informing the patient of the likely course and prognosis of the disease, informing the treating physician of the appropriate therapy and informing the scientific community of the results of well-targeted, designed and performed clinical trials. With the advent of biological therapies able to manipulate the immune response more specifically, an understanding of the pathogenesis of these conditions is increasingly important. This review presents a broad overview of the pathogenesis, diagnosis and therapy of inflammatory neuropathies, concentrating on the most commonly encountered conditions. (Source: Postgradua... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632346 Wed, 22 Jul 2009 23:00:00 +0100 2632346 http://www.medworm.com/index.php?rid=2632345&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F428%3Frss%3D1 There is large variation between individuals in their response to air pollutants. This review summarises the existing evidence that genetic factors influence the mechanisms of lung injury caused by air pollutants. Genetic association studies have compared the adverse effects of air pollutants between subjects with specific genotypes in biologically relevant genes. In human studies of ozone exposure, polymorphisms in oxidative stress genes (NQO1, GSTM1, GSTP1) modify respiratory symptoms, lung function, biomarkers and risk of asthma. Inflammatory gene polymorphisms (TNF) influence the lung function response to ozone, and the effect of different levels of ozone on the development of asthma. Polymorphisms in oxidative stress genes (GSTM1, GSTP1) alter the response to combined exposure to ragw... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632345 Wed, 22 Jul 2009 23:00:00 +0100 2632345 http://www.medworm.com/index.php?rid=2632344&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F422%3Frss%3D1 Strategies are required to reduce the personal, societal and healthcare burden caused by cerebrovascular disease. Urgent medical intervention after transient ischaemic attack (TIA) can prevent recurrent stroke, and modern healthcare has to respond rapidly to the patient with TIA. The primary care practitioner contributes to stroke prevention by rapidly and accurately diagnosing TIA and arranging urgent specialist assessment. Diagnosis of TIA in primary care is difficult, as transient symptoms are common. Stroke-screening tools are available, but there is no evidence base for diagnostic support tools for TIA in primary care. The ABCD2 scoring system identifies patients after TIA at high early risk, and secondary care assessment within 24 h is reserved for patients with a high predicted risk... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632344 Wed, 22 Jul 2009 23:00:00 +0100 2632344 http://www.medworm.com/index.php?rid=2632343&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F414%3Frss%3D1 Studies show reduced forced expiratory volume in 1 s (FEV1) in patients with chronic obstructive pulmonary disease (COPD) is an important independent predictor of cardiovascular death and is characterised by both pulmonary and systemic inflammation. Evidence shows statins have important anti-inflammatory effects in both the lungs and arteries. Although randomised control trials are yet to be reported, non-randomised studies have consistently shown benefit in COPD patients taking statins compared with those not. These include reductions in both cardiovascular and respiratory morbidity/mortality. Other potential benefits include a reduced decline in FEV1 and reduced risk of lung cancer. It is argued that confounding by a "healthy user effect" is unlikely to explain the observed benefit. Give... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632343 Wed, 22 Jul 2009 23:00:00 +0100 2632343 http://www.medworm.com/index.php?rid=2632342&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F405%3Frss%3D1 Delirium is a common condition in the elderly, affecting up to 30% of all older patients admitted to hospital. There is a particularly high risk of delirium in surgical inpatients, especially following operations for hip fracture or vascular surgery, but also for patients in the intensive care unit. Patients with delirium have higher morbidity and mortality rates, higher re-admission rates, and a greater risk of long term institutionalisation care, thereby having a significant impact on both health and social care expenditure. Delirium frequently goes unrecognised by clinicians and is often inadequately managed. Recent evidence suggests that a better understanding and knowledge of delirium among health care professionals can lead to early detection, the reduction of modifiable risk factors... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632342 Wed, 22 Jul 2009 23:00:00 +0100 2632342 http://www.medworm.com/index.php?rid=2632341&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F404%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632341 Wed, 22 Jul 2009 23:00:00 +0100 2632341 http://www.medworm.com/index.php?rid=2632340&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F399%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632340 Wed, 22 Jul 2009 23:00:00 +0100 2632340 http://www.medworm.com/index.php?rid=2632339&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F395%3Frss%3D1 Conclusions: The majority of patients were satisfied with this new style of clinic letters and expect to receive them in the future. The high satisfaction rates could be attributed to the simple and clear language used in the letters. However, the views of patients have not been reflected by GPs, with 20% of GPs preferring to receive a personally directed letter. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632339 Wed, 22 Jul 2009 23:00:00 +0100 2632339 http://www.medworm.com/index.php?rid=2632338&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1006%2F393%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2632338 Wed, 22 Jul 2009 23:00:00 +0100 2632338 http://www.medworm.com/index.php?rid=2572321&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F392%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572321 Sat, 04 Jul 2009 23:00:00 +0100 2572321 http://www.medworm.com/index.php?rid=2572320&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F383%3Frss%3D1 The aortic root links the left ventricle and ascending aorta and functions as a support structure for the aortic valve. It can be affected by a variety of congenital and acquired conditions, some of which are potentially life threatening. Echocardiography and cardiac magnetic resonance imaging are established non-invasive imaging techniques for assessing the aortic root. Recent technological advances have allowed multidetector computed tomography to emerge as an alternative means of assessing this aortic segment. This pictorial essay reviews the anatomy of the aortic root and illustrates the salient computed tomography imaging features of a range of congenital and acquired conditions that may affect it. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572320 Sat, 04 Jul 2009 23:00:00 +0100 2572320 http://www.medworm.com/index.php?rid=2572319&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F382%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572319 Sat, 04 Jul 2009 23:00:00 +0100 2572319 http://www.medworm.com/index.php?rid=2572318&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F376%3Frss%3D1 As a relative shortage of organs limits transplantation rates in many countries, the number of patients on dialysis is increasing. Nephrologists in specialist centres supervise their dialysis, but increasingly in the context of acute medical emergencies, such patients present to district general hospitals. Experience in managing patients on dialysis varies among institutions. This review aims to provide a practical guide to aid general physicians involved in the delivery of hospital care, by outlining the principles of dialysis (haemodialysis and peritoneal dialysis) and examining relevant medical issues specific to dialysis patients. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572318 Sat, 04 Jul 2009 23:00:00 +0100 2572318 http://www.medworm.com/index.php?rid=2572317&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F364%3Frss%3D1 Coronary artery disease evolves, often unnoticed, over decades, often culminating in myocardial infarction. Metabolic and behavioural risk factors affect the development and progression of atherosclerotic lesions. The diagnosis may be arrived at clinically but typically involves confirmatory and prognostic laboratory tests and imaging studies. Treatment measures are aimed at controlling symptoms and preventing disease progression. In patients with clinically stable disease, treatment centres upon preventing disease progression using lifestyle modification, medical therapy and revascularisation for patients in whom medical treatment failure may be imminently fatal. In patients with acute coronary syndrome, urgent treatment is required in order to arrest lesion progression. (Source: Postgrad... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572317 Sat, 04 Jul 2009 23:00:00 +0100 2572317 http://www.medworm.com/index.php?rid=2572316&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F358%3Frss%3D1 Lung cancer is the most common cancer worldwide and causes more deaths per year than any other cancer. It has a very poor 5-year survival rate of 8–16%, partly because of comorbidity preventing curative treatments but mainly because of the disease presenting with symptoms only when it is at an advanced and incurable stage. When lung cancer is detected earlier and is amenable to radical treatments such as potentially curative surgery and radical radiotherapy, 5-year survival rates are much higher (up to 67%). Therefore reliable detection of lung cancer at this earlier (usually asymptomatic) stage of disease should be an important way to improve outcomes. This review discusses the principles of screening with respect to lung cancer, concentrating mainly on the biological modalities use... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572316 Sat, 04 Jul 2009 23:00:00 +0100 2572316 http://www.medworm.com/index.php?rid=2572315&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F353%3Frss%3D1 In conclusion, AS in sub-Saharan Africa seems to represent a subgroup of the disease, which may open the window to a greater understanding of the pathophysiology of the condition. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572315 Sat, 04 Jul 2009 23:00:00 +0100 2572315 http://www.medworm.com/index.php?rid=2572314&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F352%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572314 Sat, 04 Jul 2009 23:00:00 +0100 2572314 http://www.medworm.com/index.php?rid=2572313&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F347%3Frss%3D1 Conclusions: Antibiotic resistance was not demonstrated in this study. Adherence to guidelines for prescribing antibiotics in patients with features of group A β-haemolytic streptococcal sore throat is poor. Information support may help to improve prescribing. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572313 Sat, 04 Jul 2009 23:00:00 +0100 2572313 http://www.medworm.com/index.php?rid=2572312&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F342%3Frss%3D1 Conclusion: Most of the clinical and laboratory features of patients with Chikungunya and Dengue fever are similar. Arthritis is the pathgnomonic sign in patients with Chikungunya fever. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572312 Sat, 04 Jul 2009 23:00:00 +0100 2572312 http://www.medworm.com/index.php?rid=2572311&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F339%3Frss%3D1 Conclusion: To improve patient care, we suggest that all chest x rays should be reviewed at an early stage during a patient’s hospital admission by a senior clinician and reported by a radiologist at the earliest opportunity. We also suggest that structured teaching on CXR interpretation should be made available for newly qualified doctors, especially with the introduction of shortened training. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572311 Sat, 04 Jul 2009 23:00:00 +0100 2572311 http://www.medworm.com/index.php?rid=2572310&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1005%2F337%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2572310 Sat, 04 Jul 2009 23:00:00 +0100 2572310 http://www.medworm.com/index.php?rid=2480222&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F336%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480222 Mon, 15 Jun 2009 04:00:00 +0100 2480222 http://www.medworm.com/index.php?rid=2480221&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F335%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480221 Mon, 15 Jun 2009 04:00:00 +0100 2480221 http://www.medworm.com/index.php?rid=2480220&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F331%3Frss%3D1 Although primary percutaneous coronary intervention (PCI) in clinical trials has lower rates of reinfarction, stroke and mortality than fibrinolytic therapy, because of system delays in routine practice, field triage and prehospital administration of fibrinolytic therapy may lead to similar clinical outcomes, especially in those patients who present in the first 2 h after symptom onset. Necessary for these outcomes is the liberal use of both rescue PCI and in-hospital revascularisation. Non-invasive prediction of failed reperfusion may be enhanced by the use of ST recovery, patient characteristics and troponin T levels, measured by point-of-care assays. This review focuses on the timing of, and indications for, an invasive strategy after fibrinolytic therapy, including that for failed phar... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480220 Mon, 15 Jun 2009 04:00:00 +0100 2480220 http://www.medworm.com/index.php?rid=2480219&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F327%3Frss%3D1 The prevalence of both osteoporosis and chronic kidney disease (CKD) increases with advancing age. Bisphosphonates are effective in the prevention and treatment of osteoporosis but current recommendations limit their use in patients with renal impairment because of concern regarding the safety profile of these agents in the setting of reduced renal function. The appropriateness of bisphosphonate treatment for patients with CKD is also in question since CKD is independently associated with a variety of skeletal abnormalities, collectively termed renal osteodystrophy, including pre-existing low bone turnover. The evidence to support the current prescribing restrictions is not robust and there are some data to suggest both that bisphosphonate treatment reduces fracture risk without an increas... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480219 Mon, 15 Jun 2009 04:00:00 +0100 2480219 http://www.medworm.com/index.php?rid=2480218&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F322%3Frss%3D1 This article discusses the drugs implicated, as well as the epidemiology, pathophysiology, clinical features, and management of drug induced parkinsonism. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480218 Mon, 15 Jun 2009 04:00:00 +0100 2480218 http://www.medworm.com/index.php?rid=2480217&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F316%3Frss%3D1 The growing popularity of activities such as hiking, climbing, skiing and snowboarding has ensured that the number of visitors to mountain environments continues to increase. Since such areas place enormous physical demands on individuals, it is inevitable that deaths will occur. Differences in the activities, conditions and methods of calculation make meaningful mortality rates difficult to obtain. However, it is clear that the mortality rate for some mountain activities is comparable to hang gliding, parachuting, boxing and other pastimes that are traditionally viewed as dangerous. Deaths in the mountains are most commonly due to trauma, high altitude illness, cold injury, avalanche burial and sudden cardiac death. This review describes the mortality rates of those who undertake recreati... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480217 Mon, 15 Jun 2009 04:00:00 +0100 2480217 http://www.medworm.com/index.php?rid=2480216&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F313%3Frss%3D1 This article summarises the importance of epidemiology to clinicians and aims to show how an understanding of epidemiological concepts can make an important contribution to optimum clinical practice in its broadest sense. Epidemiological principles can be applied to clinical practice in interpreting the results of diagnostic tests, assessing and communicating risk and prognosis, and in identifying appropriate treatment for individual patients. They are also of value to clinicians involved in planning, monitoring and improving services, teaching medical students and postgraduates, critically appraising medical literature, and undertaking or supervising research. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480216 Mon, 15 Jun 2009 04:00:00 +0100 2480216 http://www.medworm.com/index.php?rid=2480215&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F303%3Frss%3D1 Conclusion: Based on the limited data available, we conclude that the combination of digoxin with either a β-blocker or calcium antagonist should be first line management in patients with chronic atrial fibrillation. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480215 Mon, 15 Jun 2009 04:00:00 +0100 2480215 http://www.medworm.com/index.php?rid=2480214&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F299%3Frss%3D1 Natriuretic peptides such as brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are commonly used in the diagnosis and evaluation of heart failure. However, their utility in patients with chronic kidney disease (CKD) is less clear as renal dysfunction itself can be associated with elevated concentrations of these biomarkers. Given the high prevalence of left ventricular hypertrophy and left ventricular systolic dysfunction in patients with CKD, diagnosis or exclusion of heart failure becomes important in this population. Most studies to date indicate that upward adjustment of diagnostic cut points preserves the usefulness of both BNP and NT-proBNP in the CKD patient, with similar clinical performance of each biomarker. We review the role of natriuretic peptide in heart fail... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480214 Mon, 15 Jun 2009 04:00:00 +0100 2480214 http://www.medworm.com/index.php?rid=2480213&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F293%3Frss%3D1 Osteoporotic vertebral compression fractures cause pain, reduced mobility and consequently poor quality of life, and as such have a significant impact on health resources. Their prevalence can be expected to increase with the ageing population. Until recently, only conservative management has been available to alleviate pain and improve mobility. Originally developed in the 1980s to treat vascular malformation in the spine, vertebroplasty offers an interventional method for improving symptoms of vertebral compression fractures. Percutaneous vertebroplasty involves stabilisation of the fractured vertebral body using cement which is introduced via a needle under image guidance. Kyphoplasty is a more recent development in which a balloon is inflated within the fractured vertebral body in orde... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480213 Mon, 15 Jun 2009 04:00:00 +0100 2480213 http://www.medworm.com/index.php?rid=2480212&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F292%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480212 Mon, 15 Jun 2009 04:00:00 +0100 2480212 http://www.medworm.com/index.php?rid=2480211&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F288%3Frss%3D1 Conclusion: The SSS reflects severe peripheral neuropathy and is particularly prevalent among those with active foot disease. Patients who have experienced the SSS should be encouraged to seek attention and preventive action taken. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480211 Mon, 15 Jun 2009 04:00:00 +0100 2480211 http://www.medworm.com/index.php?rid=2480210&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F283%3Frss%3D1 Conclusions: Considering that 46.7% of participants did not perform BSE, and that almost all of those who did perform BSE did it incorrectly—and taking into account that a lack of knowledge on how to perform BSE was the main reason why most non-performers did not examine themselves—establishing educational programmes to teach women at risk may help in the early diagnosis of breast cancer. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480210 Mon, 15 Jun 2009 04:00:00 +0100 2480210 http://www.medworm.com/index.php?rid=2480209&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1004%2F281%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2480209 Mon, 15 Jun 2009 04:00:00 +0100 2480209 http://www.medworm.com/index.php?rid=2393351&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F224%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393351 Tue, 05 May 2009 04:00:00 +0100 2393351 http://www.medworm.com/index.php?rid=2393350&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F223%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393350 Tue, 05 May 2009 04:00:00 +0100 2393350 http://www.medworm.com/index.php?rid=2393349&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F219%3Frss%3D1 Some patients with type 2 diabetes mellitus (T2DM) are profoundly insulin resistant and require large insulin doses to achieve optimal glycaemic control. However, large volumes of subcutaneous conventional U-100 insulin can cause discomfort at the injection site, resulting in poor concordance with insulin therapy. One therapeutic option is the use of U-500 insulin, thus reducing the insulin volume by 80%. This review will address the practical issues associated with the use of U-500, clinical efficacy and safety aspects of this concentrated insulin, which has an important role in a subgroup of patients with T2DM. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393349 Tue, 05 May 2009 04:00:00 +0100 2393349 http://www.medworm.com/index.php?rid=2393348&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F213%3Frss%3D1 Primary neuroendocrine tumours (NETs) of the gallbladder are rare. In the absence of any randomised controlled trials or prospective case series, we sought trends for clinical presentation and management based on 60 patients from published literature over the last 15 years, as well as three patients from our experience, and categorised them into various subgroups according to the WHO classification for NETs. Well-differentiated NETs have an indolent course and better prognosis. Poorly differentiated neuroendocrine carcinomas, which may be of large-cell or small-cell type and may coexist with other types of carcinoma, have a poor outcome. A variety of surgical and chemotherapeutic approaches have been adopted. Surgical excision appears to prolong life, with chemotherapy perhaps adding a mar... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393348 Tue, 05 May 2009 04:00:00 +0100 2393348 http://www.medworm.com/index.php?rid=2393347&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F208%3Frss%3D1 This article reviews approaches to determining the diagnosis, aetiology and severity of acute pancreatitis, with particular emphasis on new imaging techniques. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393347 Tue, 05 May 2009 04:00:00 +0100 2393347 http://www.medworm.com/index.php?rid=2393346&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F202%3Frss%3D1 Isolated left ventricular non-compaction is a rare, morphologically distinct primary genetic cardiomyopathy, which was first described in children, but is becoming increasingly recognised in adults. The most common clinical manifestations include heart failure, arrhythmias and embolic events, and in children it may be associated with facial dysmorphisms and Wolff–Parkinson–White syndrome. Misdiagnosis may occur through lack of awareness of the condition, but with increased vigilance detailed cardiac imaging can reliably differentiate isolated left ventricular non-compaction from other pathological causes of left ventricular dysfunction. This is important because the condition may be associated with significant morbidity and mortality, and genetic counselling and echocardiograph... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393346 Tue, 05 May 2009 04:00:00 +0100 2393346 http://www.medworm.com/index.php?rid=2393345&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F196%3Frss%3D1 Epidemiological evidence suggests that, although smoking is detrimental in some skin diseases, it is of benefit in others such as pemphigus and Behcet disease. Evidence that nicotine is of therapeutic value in selected skin diseases is limited to case reports. There has been renewed interest in nicotinic acetylcholine receptor agonists, such as nicotine, after the discovery of a "nicotinic anti-inflammatory pathway". Nicotinic acetylcholine receptors exist in abundance in human skin, but it is unknown whether they exert an anti-inflammatory effect. Randomised controlled trials of nicotine preparations in those skin conditions that occur less often in smokers are necessary to establish the value of nicotine, if any, in the treatment of skin disease. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393345 Tue, 05 May 2009 04:00:00 +0100 2393345 http://www.medworm.com/index.php?rid=2393344&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F190%3Frss%3D1 The annual incidence of thyroid cancer worldwide is 1 case per 100 000 men and 2.6 cases per 100 000 women. Most thyroid nodules are asymptomatic and are discovered incidentally on physical examination, self-palpation or incidentally on imaging studies performed for unrelated reasons. Although the majority of both palpable and non-palpable thyroid nodules are benign, ~5% may represent thyroid cancer. Thyroid-stimulating hormone, thyroid ultrasound and fine-needle aspiration biopsy are key tests to guide management. Physicians caring for patients with thyroid nodules need to develop a rational, cost-effective approach to ordering and interpreting imaging and diagnostic tests in the evaluation of the thyroid nodule. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393344 Tue, 05 May 2009 04:00:00 +0100 2393344 http://www.medworm.com/index.php?rid=2393343&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F187%3Frss%3D1 Current guidelines from large randomised trials recommend that all patients with diabetes type 2 or coronary artery disease after myocardial infarction should be treated with statin drugs. However, the recent 4D and CORONA trials show no improvement in mortality in elderly patients with ischaemic heart failure and patients with diabetes and end-stage renal disease receiving haemodialysis with the onset of statin treatment. The survival benefit from statin treatment appears to stem primarily from the prevention of progression of coronary artery disease. In clinical conditions where coronary artery disease does not significantly contribute to the cause of death statins seem to be less effective. In patients at risk for organ damage, statin treatment, therefore, has to be started early in the... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393343 Tue, 05 May 2009 04:00:00 +0100 2393343 http://www.medworm.com/index.php?rid=2393342&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F186%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393342 Tue, 05 May 2009 04:00:00 +0100 2393342 http://www.medworm.com/index.php?rid=2393341&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F181%3Frss%3D1 Paediatricians have a duty to protect the life and health of their patients and to respect their autonomy. Usually, there will be no conflict between these duties. Both children and parents want effective care and agree to the medical interventions that that are most likely to provide it. However, when children refuse or resist such interventions, it may be unclear when the duty to protect trumps the duty to respect. This is because children may have differing levels of autonomy, sometimes making them competent to make medical decisions for themselves and at other times not. Further, there may be conflict between the children and their parents in such circumstances. Children may refuse treatments that parents desire or vice versa. Sometimes paediatricians may agree with the child in the fa... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393341 Tue, 05 May 2009 04:00:00 +0100 2393341 http://www.medworm.com/index.php?rid=2393340&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F176%3Frss%3D1 Conclusions: The trigger tool was successful in identifying undetected patient harm in primary-care records and may be the most reliable method for achieving this. However, the feasibility of its routine application is open to question. The tool may have greater utility as a research rather than an audit technique. Further testing in larger, representative study samples is required. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393340 Tue, 05 May 2009 04:00:00 +0100 2393340 http://www.medworm.com/index.php?rid=2393339&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F171%3Frss%3D1 Conclusions: Hyponatraemia is common in intracerebral disorders and is associated with a longer hospital stay. Cerebral irritation is associated with more severe hyponatraemia. SIADH is the most common cause of hyponatraemia and is often drug-associated. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393339 Tue, 05 May 2009 04:00:00 +0100 2393339 http://www.medworm.com/index.php?rid=2393338&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1002%2F169%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2393338 Tue, 05 May 2009 04:00:00 +0100 2393338 http://www.medworm.com/index.php?rid=2311539&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F167%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311539 Tue, 07 Apr 2009 04:00:00 +0100 2311539 http://www.medworm.com/index.php?rid=2311538&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F166%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311538 Tue, 07 Apr 2009 04:00:00 +0100 2311538 http://www.medworm.com/index.php?rid=2311537&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F163%3Frss%3D1 This report describes such a case. The patient presented with melaena and haemodynamic instability, but normal upper gastrointestinal endoscopy. Subsequent imaging with multi-detector row computed tomography angiography both localised the bleeding source to the ileum and identified the underlying tumour, resulting in considerably earlier introduction of appropriate management. The patient made an excellent recovery and remains in remission. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311537 Tue, 07 Apr 2009 04:00:00 +0100 2311537 http://www.medworm.com/index.php?rid=2311536&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F152%3Frss%3D1 The main purpose of this article is to review recent developments in the management of acute and recurrent Clostridium difficile-associated disease, with consideration of existing and new antibiotic and non-antibiotic agents for treatment. Details of the current developmental stage of new agents are provided and the role of surgery in the management of severe disease is discussed. Infection control measures considered comprise prudent use of antimicrobials, prevention of cross-infection and surveillance. Other topics that are covered include the recent emergence of an epidemic hypervirulent strain, pathogenesis, clinical presentation and approaches to rapid diagnosis and assessment of the colonic disease. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311536 Tue, 07 Apr 2009 04:00:00 +0100 2311536 http://www.medworm.com/index.php?rid=2311535&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F148%3Frss%3D1 This article looks at a disagreement that emerged at an international human rights conference between health professionals and human rights activists. The disagreement centred on the scope of the responsibilities of health professionals in relation to potential systemic human rights violations. In this article, the nature of the disagreement that emerged at the conference is explored. It is first situated in relation to a strong shared commitment to the "right of everyone to the highest attainable standard of physical and mental health"—often shortened to "the right to health" as it appears in the International Covenant on Economic, Social and Cultural Rights (ICESCR). Some of the tensions that emerged between the participants are then looked at and some of the causes of apparent dis... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311535 Tue, 07 Apr 2009 04:00:00 +0100 2311535 http://www.medworm.com/index.php?rid=2311534&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F141%3Frss%3D1 Frequent exacerbations of chronic obstructive pulmonary disease (COPD) are associated with impaired quality of life, and hospital admissions for exacerbations account for a large proportion of the expenditure of COPD. An important objective when treating COPD is to reduce the frequency of exacerbations. Studies published in the last few years have increased our knowledge on how to prevent exacerbations, but a number of questions remain unanswered. Tiotropium, inhaled steroids and long-acting inhaled β agonists reduce the frequency of exacerbations, but further studies are necessary to determine if combining tiotropium with the other inhaled medicines is more effective than using them separately. There is evidence that mucolytics and prophylactic antibiotics reduce exacerbations, but t... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311534 Tue, 07 Apr 2009 04:00:00 +0100 2311534 http://www.medworm.com/index.php?rid=2311533&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F134%3Frss%3D1 Programmed cell death (PCD) is an important terminal pathway for cells of multicellular organisms, and is involved in a variety of biological events that include morphogenesis, maintenance of tissue homeostasis, and elimination of harmful cells. Dysfunction of PCD leads to various diseases in humans, especially various cancers. Accumulating evidence indicates that PCD is closely related to anti-cancer therapy. Recently, many studies have subdivided PCD into the three categories: apoptosis, autophagy, and programmed necrosis, based on criteria such as morphological alterations, initiating death signal, and the activation of caspases. In this article, we will review the main features and functions of all three types of programmed cell death, focusing on their roles in tumour cells and the re... Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311533 Tue, 07 Apr 2009 04:00:00 +0100 2311533 http://www.medworm.com/index.php?rid=2311532&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F129%3Frss%3D1 Physical activity and weight loss are considered cornerstones of type 2 diabetes mellitus (T2DM) management programmes. However, there is much controversy and debate surrounding the relative importance of each of these factors in the treatment of T2DM. This review provides an overview of the evidence surrounding the relative importance of physical activity and weight loss in the management of T2DM and highlights key ways of initiating physical activity behaviour change. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311532 Tue, 07 Apr 2009 04:00:00 +0100 2311532 http://www.medworm.com/index.php?rid=2311531&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F128%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311531 Tue, 07 Apr 2009 04:00:00 +0100 2311531 http://www.medworm.com/index.php?rid=2311530&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F124%3Frss%3D1 Conclusions: In our institution weight estimation occurs and may result in inaccurate prescription of LMWH. Estimating a patient’s weight should be discouraged but if necessary the patient reported weight is likely to be most accurate. Unless there is significant investment in improved technology to allow obese or acutely unwell patients to be weighed, the dangerous practice of weight estimation is likely to continue. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311530 Tue, 07 Apr 2009 04:00:00 +0100 2311530 http://www.medworm.com/index.php?rid=2311528&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F119%3Frss%3D1 Conclusion: This study suggests that further technical refinement—namely, shortening the anhepatic phase duration, shielding the hepatic artery, and refining biliary duct reconstruction—can reduce the incidence of biliary complications following liver transplantation. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311528 Tue, 07 Apr 2009 04:00:00 +0100 2311528 http://www.medworm.com/index.php?rid=2311527&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F115%3Frss%3D1 Conclusions: Older patients were less likely to receive diagnostic investigations and lifestyle modification advice than younger patients. Guidelines need to be adopted to ensure prompt evidence-based stroke care in the outpatient setting. (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311527 Tue, 07 Apr 2009 04:00:00 +0100 2311527 http://www.medworm.com/index.php?rid=2311526&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F1001%2F113%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2311526 Tue, 07 Apr 2009 04:00:00 +0100 2311526 http://www.medworm.com/index.php?rid=2214664&cid=s_30435_22_f&fid=30435&url=http%3A%2F%2Fpmj.bmj.com%2Fcgi%2Fcontent%2Fshort%2F85%2F999%2F55%3Frss%3D1 (Source: Postgraduate Medical Journal) Postgraduate Medical Journal journals http://www.medworm.com/rss/comments.php?id=2214664 Tue, 24 Feb 2009 05:00:00 +0100 2214664