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Clinical Medicine: Journal of the Royal College of Physicians of London

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https://www.readbyqxmd.com/read/27956453/lymphoma-turning-biology-into-cures
#1
Thomas Cummin, Peter Johnson
Diffuse large B-cell lymphoma (DLBCL) is the commonest aggressive non-Hodgkin lymphoma with approximately 5,000 cases annually in the UK. The R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) regimen has become the international standard of care with cure rates of around 75% and despite extensive studies aimed at improving the outcomes, R-CHOP has not been superseded. Those patients that do not respond to R-CHOP have a poor outlook. DLBCL is a disease with marked molecular heterogeneity; advances in gene expression profiling and mutational analysis can be used to increase our understanding of the disease and identify new therapeutic targets...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956452/osteoporosis-advances-in-risk-assessment-and-management
#2
Juliet Compston
In the past three decades, there have been major advances in our understanding of bone biology and these have been -accompanied by a significant improvement in the management of osteoporosis. Fracture risk prediction algorithms using -clinical risk factors, with or without measurement of bone mineral density, have enabled more accurate targeting of treatment and a range of cost-effective pharmacological interventions is available to reduce fracture risk. Despite these advances, a number of challenges remain...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956451/chronic-kidney-disease-towards-a-risk-based-approach
#3
Maarten W Taal
Chronic kidney disease (CKD) affects 8-16% of adults worldwide and is associated with multiple adverse outcomes. It includes a heterogeneous group of conditions with widely varied associated risks; risk stratification is therefore vital for clinical management. Use of the CKD Epidemiology Collaboration (CKD-EPI) equation to estimate glomerular filtration rate (GFR) instead of the Modification of Diet in Renal Disease (MDRD) equation will reduce, though not eliminate, over-diagnosis of CKD. Cystatin C is recommended as an alternative measure of GFR but is not yet widely used...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956450/medical-problems-in-pregnancy
#4
Bhaskar Narayan, Catherine Nelson-Piercy
The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956449/drug-induced-liver-injury
#5
Dev Katarey, Sumita Verma
Drug-induced liver injury (DILI) remains the most common cause of acute liver failure (ALF) in the western world. Excluding paracetamol overdose, nearly all DILI encountered in the clinical setting is idiosyncratic in nature because affected individuals represent only a small proportion of those treated with such drugs. In many cases, the mechanism for idiosyncrasy is immune-mediation and is often identified by genetic risk determined by human leukocyte antigen variants. In the absence of diagnostic tests and/or biomarkers, the diagnosis of DILI requires a high index of suspicion after diligently excluding other causes of abnormal liver tests...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956448/delirium-a-guide-for-the-general-physician
#6
Oliver M Todd, Elizabeth A Teale
Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. Certain predisposing factors can make an individual more susceptible to delirium in the face of a stressor. Stressors include direct insults to the brain, insults peripheral to the brain or external changes in the environment of an individual. Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956447/towards-understanding-and-managing-chronic-cough
#7
Imran Satia, Huda Badri, Bashar Al-Sheklly, Jaclyn Ann Smith, Ashley A Woodcock
Chronic cough is a common and troublesome condition affecting approximately 12% of the general population. It is associated with poor quality of life with psychological, social and physical consequences. Patients typically complain of a dry irritating cough, driven by a strong urge to cough associated with a sensation or irritation located in the throat. Treatment of potential 'causes', ie asthma, gastro-oesophageal reflux disease and rhino-sinusitis, may produce a complete or partial response, but the response of some patients to opiates and alpha-2-delta ligand antagonists (gabapentin and pregabalin) supports the concept that this is primarily a neurological disorder, characterised by hyper-responsiveness of the nerves...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956446/beyond-pills-and-tests-addressing-the-social-determinants-of-tuberculosis
#8
Tom Wingfield, Marco A Tovar, Doug Huff, Delia Boccia, Matthew J Saunders, Sumona Datta, Rosario Montoya, Eric Ramos, James J Lewis, Robert H Gilman, Carlton Evans
Poverty drives tuberculosis (TB) rates but the approach to TB control has been disproportionately biomedical. In 2015, the World Health Organization's End TB Strategy explicitly identified the need to address the social determinants of TB through socio-economic interventions. However, evidence concerning poverty reduction and cost mitigation strategies is limited. The research described in this article, based on the 2016 Royal College of Physicians Linacre Lecture, aimed to address this knowledge gap. The research was divided into two phases: the first phase was an analysis of a cohort study identifying TB-related costs of TB-affected households and creating a clinically relevant threshold above which those costs became catastrophic; the second was the design, implementation and evaluation of a household randomised controlled evaluation of socio-economic support to improve access to preventive therapy, increase TB cure, and mitigate the effects of catastrophic costs...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956445/update-in-diagnosis-and-management-of-interstitial-lung-disease
#9
Theresia A Mikolasch, Helen S Garthwaite, Joanna C Porter
The field of interstitial lung disease (ILD) has undergone significant evolution in recent years, with an increasing incidence and more complex, ever expanding disease classification. In their most severe forms, these diseases lead to progressive loss of lung function, respiratory failure and eventually death. Despite notable advances, progress has been challenged by a poor understanding of pathological mechanisms and patient heterogeneity, including variable progression. The diagnostic pathway is thus being continually refined, with the introduction of tools such as transbronchial cryo lung biopsy and a move towards genetically aided, precision medicine...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956444/acute-respiratory-distress-syndrome
#10
Christopher Mason, Nessa Dooley, Mark Griffiths
Acute respiratory distress syndrome is a common cause of acute respiratory failure that is underdiagnosed both inside and outside of intensive care units. Progression to the most severe forms of the syndrome confers a mortality rate greater than 40% and is associated with often severe functional disability and psychological sequelae in survivors. While there are no disease-modifying pharmacotherapies for the syndrome, this progression may be prevented through the institution of quality improvement measures that minimise iatrogenic injury associated with acute severe illness...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956443/motor-neuron-disease-biomarker-development-for-an-expanding-cerebral-syndrome
#11
Martin R Turner
Descriptions of motor neuron disease (MND) documented more than a century ago remain instantly recognisable to the physician. The muscle weakness, typically with signs of upper and lower motor neuron dysfunction, is uniquely relentless. Over the last 30 years, a wider cerebral pathology has emerged, despite the lack of overt cognitive impairment in the majority of patients. From the initial linkage of a small number of cases to mutations in SOD1, diverse cellular pathways have been implicated in pathogenesis...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956442/multiple-sclerosis-a-treatable-disease
#12
Anisha Doshi, Jeremy Chataway
This article reviews our current understanding and modern treatment of multiple sclerosis (MS). MS is a disabling condition resulting in devastating social and economic impacts. As MS can affect any part of the central nervous system, the presentation is often diverse; however, there are key features that can be useful in the clinic. We comment on the diagnostic criteria and review the main subtypes of MS, including clinically isolated syndrome, relapsing remitting MS, secondary progressive MS and primary progressive MS...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956441/stroke
#13
David L Cohen, Rajaram Bathula, Joseph Devine
In this article, we briefly describe some of the challenges in delivering a stroke service in the NHS in England and how we have overcome them. Current issues are considered and research prospects described. We show that providing excellent stroke care is as much about organising services as it is about medical intervention.
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956440/acute-coronary-syndromes
#14
Tushar Kotecha, Roby D Rakhit
In the UK, there are over 80,000 admissions annually with acute coronary syndromes (ACS). Management of ST-elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PCI), which is delivered via dedicated heart attack centres. Non-ST elevation-ACS (NSTE-ACS) accounts for two-thirds of ACS presentations, affecting an older cohort of patients - often with more complex comorbidities. Initial management is with anti-thrombotic therapy with a view to PCI within 24 hours for the most acute cases and within 72 hours for all others...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27956439/heart-failure-what-s-new-and-what-s-changed
#15
Paul D Callan, Andrew L Clark
Physicians responsible for the care of patients with heart failure due to left ventricular systolic dysfunction have access to a broad range of evidence-based treatments that prolong life and reduce symptoms. In spite of the significant progress made over the last four decades, there is an ongoing need for novel therapies to treat a condition that is associated with stubbornly high morbidity and mortality. In this article, we discuss the findings of SERVE-HF, a randomised controlled trial of adaptive servo-ventilation in patients with left ventricular systolic dysfunction, as well as EMPA-REG, a study of the effects of a novel diabetic agent that may be of greater interest to heart failure specialists than diabetologists...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27927837/response
#16
Joel Abbott
No abstract text is available yet for this article.
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27927836/assessment-for-benign-paroxysmal-positioning-vertigo-in-medical-patients-admitted-with-falls-in-a-district-general-hospital
#17
Andrew M Chancellor
No abstract text is available yet for this article.
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27927835/service-contribution-and-cost-effectiveness-of-specialist-registrars-in-nhs-trusts-a-survey-and-costing-analysis
#18
Andrew Rl Medford
No abstract text is available yet for this article.
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27927834/the-independent-validation-of-the-foundation-programme-application-process-a-closer-look
#19
Fiona Patterson, Kim Walker
No abstract text is available yet for this article.
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27927833/uk-medical-education-database-an-issue-of-assumed-consent
#20
Rebecca Best, Jason Leo Walsh, Benjamin Howell Lole Harris, David Wilson
No abstract text is available yet for this article.
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
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