QJM : monthly journal of the Association of Physicians
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Review
An international study of the quality of national-level guidelines on driving with medical illness.
Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. ⋯ This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.
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Review Meta Analysis
Psoriasis and risk of venous thromboembolism: a systematic review and meta-analysis.
Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have been shown to increase venous thromboembolism (VTE) risk but the data on psoriasis is unclear. ⋯ Our study demonstrated a statistically significant increased VTE risk among patients with psoriasis.
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Review Meta Analysis
Psoriasis and risk of venous thromboembolism: a systematic review and meta-analysis.
Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have been shown to increase venous thromboembolism (VTE) risk but the data on psoriasis is unclear. ⋯ Our study demonstrated a statistically significant increased VTE risk among patients with psoriasis.
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Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder of cilia structure and function, leading to chronic infections of the respiratory tract, fertility problems and disorders of organ laterality. Making a definitive diagnosis is challenging, utilizing characteristic phenotypes, ciliary functional and ultra-structural defects in addition to newer screening tools such as nasal nitric oxide and genetic testing. There are 21 known PCD causing genes and in the future, comprehensive genetic testing may help diagnosis young infants prior to developing symptoms thus improving survival. ⋯ Standardized care at specialized centers using a multidisciplinary approach is likely to improve outcomes. In conjunction with the PCD foundation and lead investigators and clinicians are developing a network of PCD clinical centers to coordinate the effort in North America and Europe. As the network grows, care and knowledge will undoubtedly improve.
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Cancer-related pain is a common clinical problem, experienced by ∼90% of patients with cancer. The mainstay of treatment remains opioids and the WHO analgesic ladder. ⋯ The focus of this article is the mismatch between the temporal characteristics of the majority of cancer-related breakthrough pain which is fast onset and resolution, with the pharmacological profile of oral morphine. The contribution of fast-acting fentanyl preparations to the treatment of breakthrough pain and the evidence for the various commercially available preparations will be considered.