Brit J Hosp Med
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Sjögren disease (SjD) is a systemic autoimmune disorder affecting both children and adults, with a wide range of clinical phenotypes. It remains a challenging condition to recognise and diagnose early and manage effectively. The heterogeneous nature of the presentation, variable disease course and overlapping symptoms with other autoimmune conditions often result in delayed diagnosis. ⋯ They can help ensure that clinical trials are accurately capturing the impact of potential therapies on the disease and the quality of life of people with SjD. Further developments are needed in the areas of age and developmentally appropriate disease and patient-reported outcome measures, with adequate sensitivity to evaluate treatment efficacy, as well as predictor biomarkers for both treatment response and poor prognostic outcomes associated with SjD. Advancing these areas will help ensure that clinical trials adequately select the most suitable SjD cohorts to treat with a certain therapy, as well as accurately reflect the impact of a certain intervention on disease activity, progression, and quality of life, ultimately leading to better care for people with SjD.
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Malignant pleural effusion (MPE) is a common complication of malignancy and is regularly seen on the general medicine take. Diagnosis of MPE is indicative of advanced or metastatic disease and carries a poor prognosis, with median survival ranging from 3 to 12 months. Despite recent advancements in systemic anti-cancer treatment, the goal of management in MPE remains the palliation of symptoms. ⋯ Management encompasses therapeutic aspiration, chemical pleurodesis and indwelling pleural catheter insertion, each offering distinct benefits and considerations. Recent developments in equipment and combined approaches have enhanced patient outcomes and quality of life. The complexity of MPE requires a patient-centred approach to assessment and management and where possible patients should be managed with specialists in pleural disease on an outpatient basis.
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Aims/Background Child and adolescent psychiatric inpatient admissions out-of-area or to adult wards are frequently discussed in the national media. No previous systematic reviews have investigated the impact of such admissions. Methods Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, PsycArticles, King's Fund, Google Scholar, The Health Foundation, Social Care Online, Cochrane Library, Royal College of Psychiatrists, Web of Science and Econ light databases were conducted alongside grey literature searches. ⋯ For studies of admissions of under-18s to adult psychiatric wards the most commonly reported impact was on length of stay. Opinions from staff and young people of these types of admissions were mostly negative. Conclusion Further studies looking at the full range of impacts of these admissions over the long term are needed.
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Editorial Review
Diversity in Cardiovascular Care: Advancing Health Equity.
Health inequities exist in cardiovascular care and outcomes, especially among women, older people, individuals from racial and ethnic minorities, lower income and rural communities often those most vulnerable to adverse health outcomes. Such diverse groups form most of the patient population but they are rarely reflected in the composition of the cardiovascular care workforce. ⋯ Such diversity also benefits student and staff development and strengthens organizational performance. A work environment and culture that embraces and celebrates diversity will likely advance health equity.
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Cardiogenic shock (CS) is associated with significant mortality. Advances in pharmacological therapies and mechanical circulatory support (MCS) devices have markedly improved the therapeutic approach to CS, though treatment efficacy and safety vary. ⋯ Future randomised trials should evaluate a phenotype-guided pharmaco-MCS approach to the management of CS. This paper summarises contemporary pharmacological and MCS treatments for patients with CS.