QJM : monthly journal of the Association of Physicians
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Vasopressin is a peptide synthesized in the hypothalamus whose primary role is in fluid homeostasis. It has recently gained interest as a potential agent in the treatment of cardiorespiratory arrest. Initial human studies have shown benefits with vasopressin in patients with out of hospital ventricular fibrillation and asystolic cardiac arrest. ⋯ Animal studies have shown vasopressin to be a vasodilator in the pulmonary vascular system of rats, under normoxic and hypoxic conditions, with conflicting results in canines. Human studies have shown conflicting results with increases, decreases and no changes seen in pulmonary artery pressures of patients with a variety of clinical conditions. Research needs to be done in patients with pulmonary hypertension regarding the potential role of vasopressin during cardiac arrest in this subgroup.
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Randomized Controlled Trial Comparative Study
Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: a randomized controlled trial.
Complex regional pain syndrome (CRPS) following stroke aggravates morbidity. CRPS is categorized as CRPSI when no clear nerve injury is defined, and CRPSII when associated with clear nerve injury. ⋯ In this patient group, prednisolone resulted in significant improvement in the symptoms and signs of CRPSI following stroke, compared to piroxicam. Both drugs produced an improvement in the BI score.
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Management of patients with an acute coronary syndrome (ACS) requires accurate risk stratification to guide appropriate therapy. ⋯ The TIMI risk score is a valid tool for risk stratification in unselected cases with possible acute coronary syndrome. It is superior to ECG changes and troponin alone, although this simpler method also achieves good risk stratification.
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Palliative medicine services have invested in the community to support people dying at home. To develop end-of-life care for older people, we need to know where they die. ⋯ The last 20 years have seen a significant shift in location of death from the community to hospitals and care homes. Those aged over 85 years account for the biggest rise in hospital and care-home deaths. End-of-life needs for older people need to be addressed in hospital and care homes, not just in the community.
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Coronary care units were developed in the 1960s as specially equipped and staffed areas where patients with acute myocardial infarction could be monitored and offered rapid resuscitation from life-threatening arrhythmias. Awareness of the morbidity and mortality of the wider spectrum of acute coronary ischaemia was unrecognized at that time. ⋯ The traditional role of the CCU in providing early resuscitation and thrombolytic treatment for patients with ST elevation infarction has largely been devolved to the ED. The role of the CCU should be re-evaluated, and the service re-designed to provide specialist care for all presentations of acute coronary syndrome.