Clinical medicine (London, England)
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The roll out of the primary percutaneous coronary intervention pathway as the default treatment for patients with ST elevation myocardial infarction (STEMI) across the NHS has led to a paradigm shift in the model of care resulting in a significant improvement in mortality. In comparison, a similar care plan does not exist for non-ST elevation acute coronary syndrome (NSTE-ACS) despite the fact that patients presenting with high-risk non-STEMI carry a similar if not higher mortality at six months in comparison to STEMI. In this article we focus on the contemporary management of NSTE-ACS in the NHS and also look at some of the dedicated pathways already developed and implemented successfully in expediting treatment and decreasing hospital stay without compromising the safety of patients.
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Acute kidney injury (AKI) - an abrupt deterioration in renal function - causes a rise in serum creatinine (SCr) or fall in urine output. It is common, occurring in up to 20% of hospital admissions. Importantly, even small rises in SCr are associated with increased risk of death and longer hospital stays. ⋯ In practice, AKI represents a heterogeneous group of conditions, encompassing impairments in both kidney structure and function. Delivering disease-specific treatment early in the course of AKI may improve outcomes. The provision of best-practice care for all will rely on a better understanding of risk, and frameworks of care that can be applied across a diverse patient group.
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Acute kidney injury (AKI) is encountered commonly in HIV-positive patients admitted to the acute medical unit. The spectrum of AKI has changed in the era of combination anti-retroviral therapy, and now includes adverse effects of commonly used anti-retroviral drugs in addition to traditional precipitants such as severe sepsis or exposure to nephrotoxic antimicrobials. An accurate diagnosis requires careful integration of clinical data including volume status, history of potentially nephrotoxic exposures and consideration of immuno-virological status. This article provides an overview of common causes of AKI in HIV and presents a framework by which the acute care physician may approach the finding of an elevated serum creatinine in a patient with HIV.
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'Conservative care' is the management of end-stage kidney disease without dialysis, ie a palliative approach. It is now well established as the fourth treatment option alongside haemodialysis, peritoneal dialysis and transplantation, in the majority of UK renal centres.
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High salt intake is now endemic worldwide. It contributes to the generation and maintenance of high blood pressure, which is now the biggest risk factor for global disease. ⋯ Achieving a diet that is lower in salt has challenges, but is more likely to be achieved through salt reduction strategies particularly focused on processed food and through educational programs. To be effective, these interventions require collaboration between industry, health agencies and governments.