Clin Med
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Frequently patients with coronary artery disease (CAD) present with chest pain. Anginal equivalents such as dyspnoea and fatigue, or radiation of pain to the neck, jaw and arm, are also well described. Absence of chest pain with chronic left arm and neck pain is more unusual but demonstrates the heterogeneity of presentation. CAD should be considered in those anginal equivalents in the absence of 'strangling and anxiety of the breast'.
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Non-invasive ventilation (NIV) has become the standard of care for most patients with ventilatory failure due to an acute exacerbation of chronic obstructive pulmonary disease (COPD). In all but a small minority, even of the very sickest, there is little to be lost by at least a short trial of NIV. ⋯ There are no randomised controlled trials of NIV in patients with acute ventilatory failure due to obesity but the outcome from invasive ventilation is poor and the results of NIV encouraging. Finally, NIV may have a role during the transition from active care, aimed to extend life, to palliative care.
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The incidence of idiopathic normal pressure hydrocephalus (INPH) is seen to be relatively rare, ie about two per million inhabitants per year. Five studies on the prevalence of INPH in elderly patients, from three countries, have been published between 1985 and 2009.1-5 Prevalence ranged from 0.41% to 2.94% (mean 0.8%), ie slightly less than one per 100 based on samples ranging from 170 to 982 subjects. ⋯ Attempts to identify all patients with INPH overlook many cases. INPH is actually a very common disease and its prevalence increases with age.
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The objective of this study was to describe the provision of consultant rheumatology services and the pattern of inequalities in UK rheumatology service provision, and to summarise the five-year impact of the new NHS consultant contract and the Musculoskeletal Services Framework in England and Wales. All consultants on the British Society for Rheumatology/Arthritis Research UK Consultant Workforce Register in January 2007 and January 2009 were sent questionnaires about timetable and working conditions and the personal and job-related details currently held about them on the register. ⋯ Levels of provision in 2009 were lower in Scotland (1 WTE per 113,286 population) than the rest of the UK. There are now few regional variations in rheumatology consultant provision within the UK, and the number of WTE consultants is approaching recommended levels.