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dinsdag 12 september 2017

The Lancet: [Clinical Picture] Acral retiform purpura

[Clinical Picture] Acral retiform purpura
A 68-year-old man with a 10-year history of progressive IgG λ multiple myeloma and chronic kidney disease presented with a 3-week history of a painful rash on both his soles and palms, on a background of acute renal failure requiring haemodialysis. On examination he had petechiae and stellate macular purpura coalescing into retiform patches on both feet, worse on the soles (figure). A punch biopsy sample of the left palm showed mild perivascular inflammation with sparse karyorrhectic debris, extravasated red blood cells, and intravascular eosinophilic non-polarisable crystals (figure).
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[Perspectives] Taking control through drama
There is something magical about theatre. It transports you to a different place and into a different mind. Some say drama is the magic ingredient. Whatever you cook with it, it makes it better. It has the ability to provoke debate, raise questions, and reveal ambiguities in our lives. Theatre allows the audience to live through others' emotions and understand their motivations. We decided to explore the potential of drama to move the minds of adolescents about asthma and its image.
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[Articles] Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial
In patients with a general practitioner's diagnosis of symptomatic asthma and on maintenance inhaler therapy, initiation of a once-daily treatment regimen of combined fluticasone furoate and vilanterol improved asthma control without increasing the risk of serious adverse events when compared with optimised usual care.
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[Comment] Effectiveness trials in asthma: time to SaLSA?
In your next clinical consultation, you may well find yourself asking the question "What is the likelihood that this treatment will benefit this patient at this time?" Evidence-based practice answers this question with data collected under ideal conditions from a double-blind, randomised, placebo-controlled trial (RCT). However, what evidence-based practice doesn't tell us is that, when it comes to asthma and many other chronic diseases, only a minority of patients in your clinic would ever meet the eligibility criteria for these RCTs.
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[Comment] Using data to tackle the burden of amputation in diabetes
On Sept 5, 2017, Public Health England (PHE) published 2010–16 data on the incidence of amputation for diabetic foot ulcers in Clinical Commissioning Groups (CCGs) throughout the country, using data adjusted for known non-modifiable risk factors.1 The differences between localities revealed by these data highlight both the need for continued close surveillance of diabetes-related amputation rates and the opportunity for improvement.
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