Brit J Hosp Med
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There has been a significant rise in the incidence of contrast-associated nephropathy caused by administration of contrast media during cardiac interventions. This is one of the major complications of percutaneous coronary interventions, which may proceed to acute renal failure. Risk factors, including pre-existing renal dysfunction, older age and use of high osmolar contrast media, predispose patients to the development of contrast-associated nephropathy. ⋯ Prehydration, before administering contrast media, seems to be crucial. The results of studies of the relative efficacy of sodium bicarbonate and/or N-acetylcysteine in reducing the development of contrast-associated nephropathy are not consistent and any beneficial effects may depend on the pre-existing state of the kidney. This review discusses hydration of patients who are at risk of developing contrast-associated nephropathy using intravenous fluid.
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Editorial
High-quality end of life care for older people with frailty: helping people to live and die well.
Guidance from the British Geriatrics Society provides practical advice to support healthcare professionals who are involved in caring for frail, older people in the last phase of life.
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Most readers will be familiar with the term 'Wallerian degeneration' - the degenerative changes that take place in nerve fibres distal to the site of their division. Few, I would respectfully suggest, would know very much about the discoverer of this phenomenon, Augustus Waller. This year marks the 200th anniversary of his death.
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Assessing the quality of care for patients receiving long-term ventilation is complex given the diversity of this population (0-24 years in this case) and their differing requirements for treatment. This article details how and why such reviews are necessary.