Samantha L Montandon, Pritti Aggarwal, Harnish P Patel
{"title":"Frailty, multimorbidity and polypharmacy","authors":"Samantha L Montandon, Pritti Aggarwal, Harnish P Patel","doi":"10.1016/j.mpmed.2024.12.004","DOIUrl":"10.1016/j.mpmed.2024.12.004","url":null,"abstract":"<div><div>Frailty and multimorbidity are interrelated complex syndromes. Individuals living with frailty are likely to be multimorbid, but not all multimorbid individuals are frail. Frailty and multimorbidity are principal causes of polypharmacy. Together, they are associated with significant healthcare use, unscheduled hospital admissions and mortality. However, multiple medication use is not always inappropriate. Early detection of frailty, patient-centred shared decision-making and a review of multimorbid conditions underpinned by principles of personalized care support planning are the cornerstones of patient management.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 154-160"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"HIV in acute medicine","authors":"Nicholas J Norton, Andrew JV Rosser","doi":"10.1016/j.mpmed.2024.12.001","DOIUrl":"10.1016/j.mpmed.2024.12.001","url":null,"abstract":"<div><div>People with HIV can present to acute medicine services with problems related to their HIV or the consequences of a weakened immune system. A basic understanding of how to evaluate the risk of opportunistic infections and how to recognize the syndromes they cause is essential. Expert help is often needed, but prompt recognition and good early management of acutely unwell patients with HIV can prevent further deterioration.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 127-131"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2024.12.011","DOIUrl":"10.1016/j.mpmed.2024.12.011","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 172-174"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neda Akhtar Hasan, Rachael Rogers, Emma Tucker, Emily Fraser
{"title":"Long COVID","authors":"Neda Akhtar Hasan, Rachael Rogers, Emma Tucker, Emily Fraser","doi":"10.1016/j.mpmed.2024.12.007","DOIUrl":"10.1016/j.mpmed.2024.12.007","url":null,"abstract":"<div><div>The name ‘long COVID’ was first coined by patients struggling with prolonged symptoms after coronavirus disease (COVID-19) infection. It emerged formally as a clinical entity early in the COVID pandemic, and although hospitalization from the virus has dramatically declined, the incidence of long COVID remains high, affecting an estimated 2 million people in the UK in 2024 according to the Office for National Statistics. Symptoms are diverse, can fluctuate, vary in nature and emerge after mild or severe infection. Fatigue, cognitive dysfunction (brain fog) and breathlessness are major symptoms, although many more are described. These symptoms often impact daily functioning and can limit a return to work. The condition is heterogeneous and the pathophysiological mechanisms remain elusive; however, they are complex, multifaceted and likely to overlap with myalgic encephalitis/chronic fatigue syndrome. There are no currently available approved pharmacological treatments and management is supportive, focusing around rehabilitation strategies. This chapter provides an overview of the presentation, diagnosis and management of long COVID, highlighting the importance of a holistic, multidisciplinary approach to care.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 166-171"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dominic Fudge, Guhavarma Viswesvaraiah, Nikhil John
{"title":"Anaphylaxis: a distributive emergency","authors":"Dominic Fudge, Guhavarma Viswesvaraiah, Nikhil John","doi":"10.1016/j.mpmed.2024.12.009","DOIUrl":"10.1016/j.mpmed.2024.12.009","url":null,"abstract":"<div><div>Anaphylaxis, even for those prepared and experienced in its management, is a frightening scenario for patients and clinicians alike. It is best managed by simultaneous team-based emergency resuscitation, and the fundamentals to success remain the following: recognition; prompt assistance; early treatment with adrenaline (epinephrine); vigilance, monitoring and escalation if required; and recovery, safety netting and referral (with investigations and history). Anaphylaxis has a varied clinical phenotype, which means that it is often poorly identified, undertreated and thus inadequately followed up. The Resuscitation Council UK's definition is pragmatic with good sensitivity. Adrenaline is the life-saving drug but unfamiliarity with its location, dosing and preparation can lead to delay in administration and dosing errors. Patients exposed to easily avoidable triggers may not necessarily need to be discharged with an adrenaline autoinjector. Alongside local protocols, British Society for Allergy and Clinical Immunology and the National Institute for Health and Care Excellence guidelines should be consulted.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 132-137"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute dermatological emergencies","authors":"George Coltart, Adam Fityan","doi":"10.1016/j.mpmed.2024.12.002","DOIUrl":"10.1016/j.mpmed.2024.12.002","url":null,"abstract":"<div><div>Acute dermatological emergencies cover a wide range of severe skin eruptions. Several of these rashes are potentially life-threatening and carry significant morbidity and mortality. Dermatological emergencies occur across all spectrums of age, race and gender. Rapid diagnosis is vital to instigating appropriate treatment and reversing the underlying precipitant. High-quality multidisciplinary management with specialist nurses, general physicians and dermatologists is essential to ensure patients can be kept systemically stable while appropriate treatments are instigated. In this article we aim to cover some of the most significant emergency dermatological presentations and their management.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 161-165"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Suicide prevention for physicians: identification, intervention and mitigation of risk","authors":"Alys Cole-King, Stephen Platt","doi":"10.1016/j.mpmed.2025.01.001","DOIUrl":"10.1016/j.mpmed.2025.01.001","url":null,"abstract":"<div><div>General hospital doctors and general practitioners are at the forefront of suicide prevention and frequently assess patients following an episode of self-harm or with suicidal thoughts alongside a medical condition. However, traditional assessment tools, which are designed to predict individual-level risk, have been shown to be unreliable and are not useful when the clinician interacts with an individual patient. Additionally, the suicide rate in the UK is relatively low compared to the suicide rate in other high-income countries, further undermining the validity of attempts to determine who is at (greater) risk of suicide at any given time point. All patients presenting with self-harm and suicidal thoughts should be taken seriously, met with compassion and understanding, and offered personalized assessments which seek to identify risk factors, needs and strengths, instilling hope and empowering help-seeking and acceptance of support. Suicide is preventable; we need a new narrative away from ‘characterizing, quantifying and managing risk’ towards focusing on ‘compassion, safeguarding and safety planning’. We provide an overview of current research and offer clinically useful suggestions to support assessment and intervention, including signposting helpful resources for clinical encounters within primary care and the general hospital.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 113-117"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"New targeted treatments for autoimmune diseases and complications in acute medicine","authors":"Mariam Malik, Christopher R Holroyd","doi":"10.1016/j.mpmed.2024.12.006","DOIUrl":"10.1016/j.mpmed.2024.12.006","url":null,"abstract":"<div><div>Biological disease-modifying drugs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs), have revolutionized the management of autoimmune rheumatic disease. However, these medications should be used with caution, taking into account individual patient co-morbidities and evaluating the possibility of risks associated with their use. Patients given these therapies require regular blood test monitoring, close follow-up and access to prompt rheumatology advice. Patients should be aware of the possible risks, especially infection. Clinicians must be vigilant when suspecting infections in these patients, as they do not always develop the typical clinical or biochemical picture of sepsis.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 123-126"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Divya Premchandaran, Andrew Savill, Thomas Phillips, Kristin Veighey
{"title":"Management and complications of patients on renal replacement therapy on AMU","authors":"Divya Premchandaran, Andrew Savill, Thomas Phillips, Kristin Veighey","doi":"10.1016/j.mpmed.2024.12.005","DOIUrl":"10.1016/j.mpmed.2024.12.005","url":null,"abstract":"<div><div>Renal replacement therapy (RRT) describes treatments used to replace the function of the kidneys and includes haemofiltration, dialysis and kidney transplantation. Haemofiltration and its variants are used acutely, primarily in intensive care settings. Haemodialysis and peritoneal dialysis are longer term treatments used either as a bridge to renal transplantation or more permanently for individuals not suitable for a transplant. Transplantation is the only type of RRT that replaces all functions of the kidneys, including endocrine functions such as erythropoietin production and vitamin D activation. No form of RRT is without complication, and managing these patients requires specialist input. However, many clinicians, especially on acute medical units, can find themselves managing these patients acutely; therefore, what follows is key information on initial management.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 138-142"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Direct oral anticoagulants and the management of bleeding","authors":"Sara Boyce","doi":"10.1016/j.mpmed.2024.12.008","DOIUrl":"10.1016/j.mpmed.2024.12.008","url":null,"abstract":"<div><div>Venous and arterial thromboembolism are a major health burden worldwide and oral anticoagulation is fundamental in treating and preventing many thrombotic disorders. Direct oral anticoagulants (DOACs) have replaced traditional vitamin K antagonists for many indications for oral anticoagulation. Large Phase III studies and meta-analyses have shown that the risk of intracranial and fatal bleeding with DOACs is lower than with vitamin K antagonists. Despite this, when DOACs were first approved there was hesitancy among clinicians to prescribe them because of challenges in managing major bleeding, leading to the development and approval of two DOAC-specific reversal agents. Clear protocols ensuring the swift recognition and treatment of patients bleeding on DOACs, along with access to specific reversal agents and coagulation factors, improves patient outcomes.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 3","pages":"Pages 118-122"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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