Clinical medicine (London, England)
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Hyperlipidaemia is a major risk factor for the development of atherosclerosis and cardiovascular disease. Statins are the mainstay of therapy and new guidelines focus on the use of these agents without specific targets for low-density lipoprotein (LDL)-cholesterol or non high-density lipoprotein (HDL)-cholesterol. ⋯ Specialised therapies are in development for treatment of orphan disoders such as homozygous familial hypercholesterolaemia (lomitapide) or familial chylomicroaemia (alipogene tiparvovec). These novel lipid-lowering agents are likely to find uses in treating patients at the highest cardiovascular risk.
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Idiopathic pulmonary fibrosis (IPF) is a devastating condition with a poor prognosis and few treatment options. However, recent research into this condition has led to considerable insights into the pathophysiology of the disease, resulting in the identification of potential biomarkers to aid diagnosis and stratification of patients and the development of novel therapies. In this review we will discuss the recent developments in this field and review how this knowledge has been translated into clinical trials and a paradigm shift in our approach to patients with IPF.
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Exercise has a beneficial effect on metabolic parameters affecting cardiovascular risk, such as lipids and blood glucose, and is a key component in both the prevention and the management of type 2 diabetes. Glycaemic control improves with both aerobic and resistance exercise in type 2 diabetes, but no glycaemic benefit is seen in type 1 diabetes. ⋯ Low and moderate intensity exercise are generally associated with a fall in blood glucose, and high intensity exercise can be associated with a rise in blood glucose. Trial evidence is suggestive of a reduction in cardiovascular risk with exercise, although evidence from prospective, randomised controlled trials is certainly not conclusive.
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We carried out a cross-sectional online survey of fellows and members of the Royal College of Physicians to establish physicians' experiences of adverse patient safety events and near misses, and the professional and personal impact of these. 1,755 physicians answered at least one question; 1,334 answered every relevant question. Of 1,463 doctors whose patients had an adverse event or near miss, 1,119 (76%) believed this had affected them personally or professionally. 1,077 (74%) reported stress, 995 (68%) anxiety, 840 (60%) sleep disturbance and 886 (63%) lower professional confidence. 1,192 (81%) became anxious about the potential for future errors. ⋯ Adverse safety events affect physicians, but few formal sources of support are available. Most doctors use incident-reporting systems, but many describe a lack of useful feedback, systems change or local improvement.
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Diabetes is an increasingly common health problem, and accounts for one-tenth of NHS spending, chiefly managing avoidable complications. Approximately one-third of people with diabetes have psychological and/or social problems which impede their ability to self-manage their diabetes. ⋯ Ensuring that any mental health problems are treated and social needs are met, will be valuable in improving the individuals health. Addressing the psychiatric and psychological barriers to good glucose control can help to reduce the burden of diabetes and its complications, on both the individual and the wider health service.