Clinical medicine (London, England)
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Chronic cough is a common and troublesome condition affecting approximately 12% of the general population. It is associated with poor quality of life with psychological, social and physical consequences. ⋯ Novel and highly effective neuronal treatments are in development and offer hope of better symptom control with fewer side effects within a few years. This review focuses on understanding the mechanism of chronic cough, current management approaches and research that may lead to novel therapies.
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Chronic kidney disease (CKD) affects 8-16% of adults worldwide and is associated with multiple adverse outcomes. It includes a heterogeneous group of conditions with widely varied associated risks; risk stratification is therefore vital for clinical management. ⋯ A new classification system for CKD, which includes GFR and albuminuria, has been endorsed by the National Institute for Health and Care Excellence to aid risk stratification and a recently validated formula, requiring only age, gender, eGFR and albuminuria, is useful to predict risk of end-stage kidney disease (ESKD). A risk-based approach will facilitate appropriate treatment for people at high risk of developing ESKD while sparing the majority, who are at low risk, from unnecessary intervention.
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Non-invasive positive-pressure ventilation (NPPV) has assumed an important role in the management of respiratory failure because it provides ventilatory support without the need for an invasive airway. However, its effectiveness remains unclear. ⋯ The usage of NPPV was associated with significantly decreased intubation (pooled OR=0.23, 95% CI 0.12-0.42, p<0.001) and ICU mortality rate (pooled OR=0.34, 95% CI 0.20-0.60, p<0.001), but did not influence the hospital mortality rate (pooled OR=0.77, 95% CI 0.32-1.81, p=0.543) and the length of ICU or hospital stay (ICU stay: difference in means=0.38, 95% CI -3.01 to 3.77, p=0.825; hospital stay: difference in means=2.76, 95% CI -1.74 to 7.27, p=0.229). In conclusion, usage of NPPV in patients with ARF is associated with lower intubation and in-ICU mortality rate.
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The field of interstitial lung disease (ILD) has undergone significant evolution in recent years, with an increasing incidence and more complex, ever expanding disease classification. In their most severe forms, these diseases lead to progressive loss of lung function, respiratory failure and eventually death. ⋯ The diagnostic pathway is thus being continually refined, with the introduction of tools such as transbronchial cryo lung biopsy and a move towards genetically aided, precision medicine. In this review, we focus on how to approach a patient with ILD and the diagnostic process.
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The national picture of the comparative costs and diagnoses of hospitalised homeless patients are examined using the 'no fixed abode' flag in English hospital statistics. Comparable studies sample patients in single cities, eg New York and Toronto. The most common diagnosis is substance misuse; the share of homeless NHS patients with this diagnosis is rising, and now equals that found in North American cities. ⋯ Hospital costs for homeless patients - both total and per admission - have fallen significantly in recent years, primarily because of fewer admissions and shorter lengths of stay for mentally ill patients. Aims to reduce NHS costs at the level of individual institutions have often shaped policy. Broader policy to prevent and reduce homelessness offers substantial long-term reductions in the cost of chronic care.