International journal of clinical practice
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Int. J. Clin. Pract. · Jul 1997
The impact of pre-clerking clinics on surgical operation cancellations: a prospective audit.
Pre-clerking of all patients undergoing elective general surgical operations was introduced at our hospital in an attempt to reduce an unacceptably high operation cancellation rate. A prospective audit has been performed on the effect of this policy on the cancellation rate. Before the introduction of pre-clerking there was a marked seasonal variation in the number of patients who failed to attend for surgery, which could be explained by absence on holiday. This seasonal variation disappeared after the start of pre-clerking clinics, but there has been no reduction in the number of cancellations for medical reasons.
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Int. J. Clin. Pract. · Jul 1997
Case ReportsSuicide attempt due to metoclopramide-induced akathisia.
Akathisia as a side-effect of metoclopramide has received increasing attention in consultation-liaison psychiatry in recent years. A case of metoclopramide-induced akathisia resulting in a suicide attempt is reported in order to highlight the suffering of such patients and the factors that lead to misdiagnosis.
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Int. J. Clin. Pract. · Jun 1997
Biography Historical ArticleOn the causes of collapse and sudden death by Avicenna.
Avicenna's views on the causes of collapse and sudden death are presented from a literal translation of the mediaeval Arabic text. Medical knowledge based on observation mixed with pure abstract reasoning forms the essence of Avicenna's medical writings.
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The pathogenesis of sepsis involves not only microbial toxins but also activated host inflammatory mediators. Therefore, besides conventional antibiotic or surgical treatment of infection and supportive intensive therapy, modulating host inflammatory mediators as a conjunctive therapeutic option has been explored in the past decade. Although successful in animal models of sepsis, inhibiting host inflammatory response in human sepsis has failed to improve survival or otherwise show efficacy. Studies are needed which better describe the circumstances under which these therapies may ultimately prove successful.
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Int. J. Clin. Pract. · Jun 1997
Case ReportsWidening of the mediastinum following a sternal fracture.
Sternal fractures, once thought of as uncommon, occur with increasing frequency, parallelling the incidence of motor vehicle accidents. A fractured sternum can produce a widening of the mediastinum even in the absence of an aortic injury. The Advanced Trauma Life Support course teaches that a widening of the mediastinum after blunt chest injury is an indication for aortography. In this case report we recommend computerised axial tomography (CT) scan of the chest as the investigation of choice in the non-hypotensive patient who has sustained a fractured sternum after a blunt chest trauma, and who has widening of the mediastinum on the chest X-ray, with no other radiological features suggesting traumatic aortic rupture.