Search & Filter

Carotid endarterectomy is a surgical procedure in which an atherosclerotic plaque is removed from the carotid artery to avoid future stroke. A small proportion of patients will have adverse effects from surgery and need emergency blood-pressure management to avoid intracranial haemorrhage. This paradoxical risk of operation-related stroke leads to continuing controversy about this procedure. Large randomised trials have shown good evidence of benefit in symptomatic patients. However, despite the benefits of swift treatment, patients in the UK are still likely to have significant delay to treatment.

The vision of the British Heart Foundation is of a world in which people do not die prematurely of heart disease. The charity, which was created in 1961, hopes to achieve this through pioneering research, vital prevention activity and by ensuring quality care and support for people living with heart disease. This article reviews its work on heart failure.

Breast cancer is the collective term for all the cancers that originate in breast tissue. Most of these begin in the glandular tissue, though the most common of all breast cancers starts in the ducts. Breakthrough Breast Cancer is a UK charity that aims to ensure every person affected by breast cancer gets the best treatment, information and support. This article reviews its research work.

Dehydration in frail, elderly, nursing-home residents is a common problem usually leading to hospital admission for rehydration with intravenous fluids. Such admissions increase pressure on secondary care and may cause distress to the patient. We consider the use of subcutaneous fluids in elderly patients, and its potential role as an element of care near to home.

Revalidation is almost upon us. Relicensing should, subject to legislation, finally start this autumn, followed by recertification as part as a 5-year rolling programme. The impact this will have on consultants' continuing professional development is beginning to take shape. For many consultants, attending at least one annual geriatric conference has been a crucial part of their ongoing education. Will that continue?

Anaemia is a commonly encountered clinical entity. It can affect women of all ages and is not an ultimate diagnosis. An underlying aetiology should always be sought.

Doctors have a duty to advise patients about the legal obligations of driving license holders when diagnosed with dementia. If patients do not follow advice, adopting proportionate and incrementally assertive steps leading to direct reporting to relevant agencies, where necessary, will be at the heart of good practice.

Within chronic pain states, neuropathic pain is often poorly recognised, yet its presence worsens prognosis and complicates treatment. Although it often exists in isolation after damage to nerves, more commonly it occurs alongside inflammatory pain.

I was very impressed by the article Positive solutions in chronic pain that appeared in GM January 2009. I have experienced both sides of the problem of chronic pain, first as a general practitioner (recently retired), and now as a patient. I can confidently say that our local hospital has a hiddden agenda of ageism pervading across the board, and this probably applies to other NHS hospitals. It seems strange that even in the ninth year of the 21st year century, the cut-off from youth to senility is 65 years and has remained so for many decades, despite all the developments and advances in medical science and in living conditions.

The UK Lung Cancer Coalition is a partnership of charities, clinicians, senior NHS professionals and health-care companies with a commitment to double lung cancer survival. It is the nation's only multi-interest group in lung cancer.

Little attention is given to palliative care for patients with non-cancer disease such as end-stage renal failure. Sometimes dialysis either cannot be started or needs to be stopped in elderly patients with multiple comorbidities. Palliative care for such people is advocated by guidelines, but many renal services do not have adequate palliative components.

Gout is a very common disease, particularly in older men. It manifests as swollen painful joints resulting from intra-articular deposition of monosodium urate crystals. Initial treatment is with high doses of non-steroidal anti-inflammatory drugs, and if patients are unresponsive, colchicine or corticosteroids can be used.

Around a third of osteoporotic fractures occur in men. Generally, hip fractures are associated with high rates of morbidity, disability, and mortality.

Good communication skills are essential, particularly in the care of older people. Interactions between doctors and patients or patients' relatives will increase since the arrival of lasting power of attorney, implemented with the Mental Capacity Act in 2005. This article looks at the special nature of communication between the doctor, older patients, and their relatives.

The skin of the legs can be affected by several disorders such as venous ulcers and forms of eczema, as well as purpura, cancers, and infections. Since the legs are usually covered by clothing, patients might not know about the condition until it is fairly advanced.