QJM : monthly journal of the Association of Physicians
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Bronchiectasis is a chronic debilitating condition with considerable phenotypic diversity. A vicious cycle of infection and inflammation exists in damaged airways with patients suffering from persistent cough, purulent sputum production, recurrent chest infections and general malaise. ⋯ Further research is essential to improve our understanding of the development and progression of this disease. This article reviews what is currently known about bronchiectasis, its pathophysiology, aetiology and management strategies.
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It is estimated that there are 35.6 million people with dementia worldwide and this is projected to increase to over 115 million by the year 2050. Dementia is a progressive neurodegenerative disease that significantly reduces survival. ⋯ This review highlights results from a large UK study of informal carers of people with dementia to explore what are determinants of care for people with dementia and their family carers. New perspectives as to models of care for end-of-life care for patients with dementia are discussed together with how these may be implemented and delivered within wider community settings and contexts, where many people with dementia may be cared for in the future.
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Physicians involved in the care of medical inpatients, irrespective of their sub-specialty area, will be responsible for the management of a significant number of older adults with complex care needs and multiple co-morbidities. These patients are vulnerable to poor outcomes (including falls, institutionalization and death)--a vulnerability often linked with the term 'frail' or 'frailty'. Frailty is associated with advanced chronological age and chronic disease but is a separate construct. ⋯ We explore how falls, a common cause of morbidity and mortality in older patient groups, may be a manifestation of increasing frailty and argue that falls services should avoid the practice of pursuing a single-organ cause when there are likely to be several contributing factors at play. We also consider the impact of frailty on medication prescribing and discuss how individualized prescribing could reduce the risk of adverse drug reactions in at-risk older inpatients. While it can be frustrating for physicians to manage patients who do not fit well into disease-based diagnostic and management algorithms, understanding frailty has the potential to improve the clinical care of vulnerable older people in the hospital setting.
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Idiopathic pulmonary fibrosis (IPF) is a progressive age-related lung disease, the cause of which is not been fully understood. IPF is a devastating disease with mortality worse than many cancers, and treatment options are limited. IPF is thought to occur after recurrent injury to the alveolar epithelium followed by abnormal repair characterized by the formation of fibroblast and myofibroblast foci and excessive deposition of extracellular matrix. ⋯ On the whole, these have disappointed. Improvements in molecular techniques have developed our understanding of IPF and with it identified new pathways and potential targets for therapeutic intervention. These insights are leading to interest in biomarkers of disease progression and prognosis and to novel anti-fibrotic agents and a more targeted approach to the treatment of IPF.