Postgraduate medical journal
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Dementia is a progressive life limiting condition with increasing prevalence and complex needs. Palliative care needs of patients with dementia are often poorly addressed; symptoms such as pain are under treated while these patients are over subjected to burdensome interventions. Research into palliative care in dementia remains limited but recent developments together with national guidelines and policies set foundations for improving the delivery of palliative care to this group of the population.
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Biography Historical Article
Sir Henry Halford, president of the Royal College of Physicians, with a note on his involvement in the exhumation of King Charles I.
Henry Halford (formerly Vaughan) (1766-1844) was president of the Royal College of Physicians for an unprecedented 24 years. A successful physician, he had to resign his post at the Middlesex Hospital because of his growing private practice. He was physician to four reigning monarchs and had many famous patients including Geogiana Duchess of Devonshire in whom he correctly diagnosed a liver abscess when other physicians had failed. He was also involved in the exhumation of King Charles I, and the fourth cervical vertebra, through which the King had been executed, came into his possession.
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To assess the glucose tolerance of South Asian and Caucasian women with previous gestational diabetes mellitus (GDM). ⋯ GDM represents a significant risk factor for future DM development regardless of ethnicity. Glycated haemoglobin values at GDM diagnosis have value in predicting future diabetes mellitus.
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Spontaneous bacterial peritonitis (SBP) is the infection of ascitic fluid in the absence of any intra-abdominal, surgically treatable source of infection. Despite timely diagnosis and treatment its reported incidence in ascitic patients varies between 7-30%. Ascitic paracentesis remains the chief diagnostic procedure. ⋯ Examination of the fluid is not complete unless the sample is inoculated in blood culture bottles. Treatment is currently with third-generation cephalosporins or oral quinolones. Following a single episode of SBP patients should have long term antibiotic prophylaxis.
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Optimum heart failure medication and an increasing array of interventions have had an enormous effect on morbidity and mortality over the past 10 years. However, patients with end stage disease can still be highly symptomatic. ⋯ They are also less likely to have the opportunity to plan for care with regard to death and dying. There is increasing demand that the multi-professional clinical team gain good communication and supportive care skills, and that appropriate access to specialist palliative care services is available.