Clinical medicine (London, England)
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The frailty syndrome is defined as a decrease in physiological reserve across multiple organ systems leading to increased vulnerability to external stressors. Studies across surgical subspecialties and in emergency and elective settings have identified frailty as an independent predictor of adverse postoperative clinician-reported, patient-reported and process-related outcomes. ⋯ Multiple tools to screen and diagnose frailty exist with limited appraisal of clinometric properties. A pragmatic approach to these tools is advocated with a future focus on collaborative approaches to modify the syndrome using multicomponent methodology such as comprehensive geriatric assessment and adapt the pathway to the needs of the frail surgical patient.
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QRS electrical alternans is characterised by alternating amplitude of the QRS complexes, and is well-documented in cardiac conditions such as pericardial effusion. We describe a case of QRS alternans in a patient with gastric volvulus.
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Case Reports
Ovarian cyst haemorrhage as a complication of acute myelomonocytic leukaemia induction therapy.
Here we present a case of acute ovarian cyst haemorrhage in a young female during induction therapy for acute myelomonocytic leukaemia (AMML). ⋯ This highlights the importance of recognising coexistent pathology in patients undergoing high intensity chemotherapy.
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In this paper, I discuss the central importance of the clinical consultation to defining the potential outcomes for an episode of care. The consultation is also crucial to patient safety. ⋯ Better consultations would reduce the possibility of misdiagnosis and also improve patient outcomes, patient experience, patient safety and staff satisfaction. It is high time we improved clinical consultations in hospital settings.
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Decisions on how and when to treat an abdominal aortic aneurysm involve a number of clinicians; interventional radiologists and vascular surgeons assess the technical ability to repair the aneurysm. Patients' fitness and past medical history is assessed to estimate their short- and long-term survival with or without surgery. Most importantly the patients' personal preference for treatment must be identified. Getting a patient to share what matters most to them requires shared decision making.