Brit J Hosp Med
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Primary glomerulonephritis comprises several renal-limited diseases that can cause haematoproteinuria, chronic kidney disease, nephrosis and end stage kidney disease. The most common of these are IgA nephropathy (IgAN), primary membranous nephropathy (PMN), Focal Segmental Glomerulosclerosis (FSGS) and Minimal Change Disease (MCD). Although rare, these diseases cause a significant burden to health care systems, given the high cost of treating End Stage Kidney Disease (ESKD) with dialysis or transplantation. ⋯ However, recent advances in understanding of how these diseases evolve has led to the introduction of novel therapeutic agents. Trials are underway or have recently completed that have huge implications for the standard of care for the primary glomerulonephritidies, and should dramatically reduce the number of patients who progress onto end stage kidney disease. This article reviews the international Kidney Disease Improving Global Outcomes (KDIGO) guidelines for the treatment of IgAN, PMN, FSGS and MCD, as well as recent research on pathogenesis and treatment.
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Vasopressor medications for circulatory shock have historically been administered through central venous catheters due to concern for extravasation injury when given peripherally. However, recent studies have demonstrated the safety of peripheral administration of vasopressor medications at lower doses and for a limited duration. Peripheral use of vasopressors is appealing to both patients and providers, as obtaining central access is an invasive procedure associated with the risk of pneumothorax, bleeding, and infection. ⋯ We discuss the guidelines and data for optimal dose, duration, intravenous line (IV) size, IV location, and nursing IV site monitoring for peripheral vasopressors. We then explore adverse events associated with peripheral vasopressors. Finally, we describe how this practice change may impact hospital medicine providers.
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Review
Don't forget the children-paediatric patients in mass casualty events and major incident planning.
Major incidents and mass casualty events can affect people of all ages. However, when planning the response to a major incident the focus is often on adult casualties rather than children. ⋯ The new Major Incident Triage Tool introduced in the National Health Service (NHS) in 2024 has a tendency to over triage paediatric casualties and so hospitals who may be receiving children following a UK major incident must be aware of this and plan for the potential implications. This article reviews the evidence and learning from previous mass casualty events and makes recommendations for hospitals to ensure that the needs of children will be met if a major incident occurs.
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Review
The influence of open-skill and closed-skill sports on executive functions: a systematic review.
Aims/Background Open-skill sports are reportedly more effective than closed-skill sports in improving executive functions. However, it remains unclear as to its superiority in specific components of executive functions and specific populations. This review aims to explore the degree to which specific components of executive functions are affected by different sport types, open-skill sports and closed-skill sports, among different age groups. ⋯ Six studies found that open-skill sports are conducive to inhibitory control and cognitive flexibility among children and adolescents, while four studies showed that open-skill sports greatly enhance inhibitory control in elderly individuals. Conclusion Compared with closed-skill sports, open-skill sports have a favourable impact on inhibitory control and cognitive flexibility in children, adolescents, and adults, marked by shorter response time in inhibitory control tasks, as well as shorter response time and lower switch costs in cognitive flexibility tasks. In addition, relative to closed-skill sports, open-skill sports heightens accuracy in working memory tasks among adults.
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Acute aortic dissection is a cardiovascular emergency that should be recognised on presentation in the Emergency Department (ED) because clinical outcome is time-dependent. In suspected cases of acute aortic dissection, immediate imaging with chest computed tomography scan followed by transthoracic echocardiography (TTE) is essential to confirm diagnosis. Immediate medical management is aimed at controlling the heart rate (60-80 beats/min), systolic blood pressure (100-120 mmHg) and pain. Patients with Type A acute aortic dissection should immediately be referred to the cardiothoracic surgeons for emergency aortic surgery while those with Type B acute aortic dissection should be referred to the vascular surgeons for surgical/endovascular interventions if indicated.