Clinical medicine (London, England)
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Review Historical Article
100 years of the Royal Air Force's contribution to medicine: providing care in the air and delivering care by air.
The Royal Air Force (RAF) came into being during World War I as the world's first independent air force on the 1 April 1918, amalgamating elements of the Royal Flying Corps (RFC), itself established in 1912 and the Royal Naval Air Service which had formally separated from the Admiralty's administered Air Wing of the RFC in 1915. The RAF therefore celebrates its 100th anniversary in the same year that the Royal College of Physicians of London celebrates its 500th. This article will cover the contribution that military aviation has made to medicine since 1913 with the emphasis of three examples focusing on delivering care by air, providing care in the air and in developing systems for supporting aircrew or patients at the extremes of physiological stress.
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Autologous haematopoietic stem cell transplantation (aHSCT) is commonly used for the treatment of haematological cancers, but is increasingly used in the treatment of patients severely affected by autoimmune diseases (ADs). In fact, ADs have become the fastest growing indication for aHSCT. A wide range of diseases have been treated, but the field has focused on three areas: multiple sclerosis, diffuse cutaneous systemic sclerosis and Crohn's disease, where there are populations of patients for whom disease control remains unsatisfactory despite the advent of biological and targeted small molecule therapies. ⋯ Even so, the treatment with aHSCT is intensive with a range of toxicities and risks which, despite being routine to transplant haematologists, are less familiar to disease specialists. Close collaboration between transplant haematologists and relevant disease specialists in patient selection, clinical management and follow-up is mandatory. Ideally, patients should be treated on a clinical trial if available.
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Cellular therapy is a key tool to treat haematological malignancies. Over 40,000 allogeneic and autologous haematopoietic stem cell transplants (HSCTs) are performed annually across Europe.1 Since 2017, a new T cell therapy, chimeric antigen receptor-T (CAR-T) cells have been licensed outside clinical trials. ⋯ Patients frequently require admission to intensive care, and management from a number of medical specialties. This exciting and powerful new therapy requires the formation of new multispecialty medical teams for safe delivery and to successfully manage the resultant complications.
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Safe exclusion of pulmonary embolism (PE) is a common problem in acute medicine. Common care pathways usually involve the use of a pre-test probability score with a D-dimer test to aid clinical decision-making. Unfortunately, the specificity of many D-dimer assays decreases with age. ⋯ D-dimers in patients with low or moderate Wells score were analysed for both conventional and age-adjusted cut-offs. The use of an adjusted D-dimer showed a sensitivity of 0.97 (95% CI 0.9-1.0) while the specificity increased from 0.07 (95% CI 0.04-0.11) for the conventional cut-off to 0.32 (95% CI 0.27-0.38) for the age-adjusted cut-off. Using a 5 x patient's age-adjusted D-dimer cut-off is both safe and showed an increased specificity comparable to those published previously on other D-dimer assays.