Clin Med
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Pulmonary embolism (PE) continues to be associated with significant mortality despite advances in the diagnostic techniques available for its detection. Anticoagulation remains standard treatment in PE although there is a consensus view that 'step-up' to thrombolytic therapy in addition to anticoagulation is indicated in those patients who are systemically shocked at presentation--a group defined as having suffered 'massive pulmonary embolism'. ⋯ In particular, the potential benefit of extending thrombolytic therapy to include those patients with sub-massive PE has been the subject of much enquiry and debate. This review examines the evidence for thrombolytic therapy and explores the potential for risk stratification in PE.
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Recent developments in the field of diabetes and endocrinology have led to greater understanding of the body's complex hormonal axes. This article reviews the latest significant treatments which have the potential to impact greatly on a wide variety of disease states in the not too distant future.
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It is a concern that increasing pressure to diagnose, treat and discharge patients rapidly is leading to unacceptably high readmission rates. Readmissions were studied over a two-month period. Patients were identified through the hospital coding system, and electronic discharge summaries provided details of each admission. ⋯ Readmission is more likely in older patients with complex care needs. Rapid throughput of patients is not associated with readmission. The majority of readmissions can potentially be avoided with judicious medical care.
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John Hughlings Jackson (1835-1911) first clearly described apraxia in 1861, though he did not provide the specific name. Apraxias are subtle motor disorders in which there is an interruption of the organisation of movement mainly located in the left hemisphere. ⋯ This notion was later expanded and clarified by Geschwind's 'disconnection syndromes'. This article summarises the history of this important and common pattern of motor dysfunction.