Improving the management of spontaneous bacterial peritonitis in cirrhotic patients: assessment of an intervention in trainee doctors.
Abstract
Spontaneous bacterial peritonitis (SBP) in cirrhotic patients is a serious complication associated with a high mortality rate. A baseline audit of the acute medical take (AMT) at Northwick Park suggested a lack of awareness regarding management. A questionnaire based on contemporary SBP guidelines was circulated to all trainee doctors (FY1 to SpR). Ascitic fluid testing requests were analysed over a six-month period. The electronic requesting system was updated to include prompts and direct links to Trust SBP guidelines, and a one-hour lecture to all members of the AMT, supported by an educational...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Rawson TM, Bouri S, Allen C, Ferreira-Martins J, Yusuf A, Stafford N, Pitcher M, Jacyna M Tags: Clin Med Source Type: research
Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle.
Abstract
Acute kidney injury (AKI) is common in hospitalised patients but is known be suboptimally managed; the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report in 2009 identified significant failings in AKI care. An audit, using standards suggested by the NCEPOD report, of all adult inpatients with AKI in a large central-London NHS hospital in a 7-day period in 2011 showed poor recognition and management of AKI. In response, an AKI 'care bundle' was developed and deployed throughout the hospital along with a programme of enhanced education. Re-audit in 2013 showed that AKI was...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Joslin J, Wilson H, Zubli D, Gauge N, Kinirons M, Hopper A, Pile T, Ostermann M Tags: Clin Med Source Type: research
Experience from two decades of the Cambridge Rapid Access Neurology Clinic.
We report on the evolution of the rapid access neurology clinic (established in 1995) at Addenbrooke's Hospital, Cambridge. Annualised attendance data demonstrate an ever increasing demand, with primary headache disorders now accounting for more than 40% of referrals. Secondary causes of headache (including intracranial tumours, idiopathic intracranial hypertension, carotid or vertebral artery dissection and subdural haematomas) remain infrequent. In all such cases, there were additional diagnostic clues. The number of patients referred with problems related to chronic neurological diseases has fallen considerably, reflect...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Axinte LT, Fiddes BD, Donaghy A, Whyte A, Allen C, Sawcer SJ, Adam RJ, Stacpoole SR Tags: Clin Med Source Type: research
Management of cardiovascular conditions in a cohort of patients with HIV: experience from a joint HIV/cardiology clinic.
Abstract
The aim of this study was to assess cardiovascular diagnoses and management in a cohort of patients diagnosed with HIV, and the performance of a joint HIV/Cardiology Clinic in a tertiary hospital setting. A retrospective analysis was performed on all patients referred to a joint HIV/Cardiology Clinic at our hospital. Data on 120 patients were collected. In this predominantly male population (male 101 and female 19) coronary artery disease (CAD) was the most common diagnosis (34%, n = 41). Other diseases included hypertension (12.5%, n = 15), cardiomyopathy (12.5%, n = 15) and arrhythmia (6%, n = 8...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Koganti S, Kinloch-de Loes S, Hutchinson S, Johnson M, Rakhit RD Tags: Clin Med Source Type: research
Sexual health issues in adolescents and young adults.
Abstract
Adolescence is a time of sexual risk-taking and experimentation but also vulnerability. Young people may present to general physicians with systemic symptoms of sexually transmitted infections (STIs), such as arthritis, hepatitis or rash, but may not necessarily volunteer information about sexual activity. It is important for physicians to ask directly about sexual risks and if appropriate test for STIs and pregnancy. Knowing how to take a sexual history and consent a patient for an HIV test are core medical skills that all physicians should be trained to competently perform. Safeguarding young pe...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Forsyth S, Rogstad K, BASHH Adolescent Special Interest Group Tags: Clin Med Source Type: research
Drug therapies in severe asthma - the era of stratified medicine.
Abstract
Difficult-to-treat asthma affects up to 20% of patients with asthma and is associated with significant healthcare cost. It is an umbrella term that defines a heterogeneous clinical problem including incorrect diagnosis, comorbid conditions and treatment non-adherence; when these are effectively addressed, good symptom control is frequently achieved. However, in 3-5% of adults with difficult-to-treat asthma, the problem is severe disease that is unresponsive to currently available treatments. Current treatment guidelines advise the 'stepwise' increase of corticosteroids, but it is now recognised th...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Hetherington KJ, Heaney LG Tags: Clin Med Source Type: research
Tackling emerging infections: clinical and public health lessons from the West African Ebola virus disease outbreak, 2014-2015.
Abstract
The magnitude of the 2014-2015 West African Ebola virus disease outbreak was unforeseen at its onset and the initial international response was slow. The high mortality and the panic that this outbreak induced had a major effect on health systems. In this article we discuss some of the key public health and clinical lessons from this Ebola outbreak, including combining epidemiology, modelling and anthropology, and the initial evidence for the importance of fluid and antibiotic management.
PMID: 26430185 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Walker NF, Whitty CJ Tags: Clin Med Source Type: research
Stroke rehabilitation: long-term rehabilitation after stroke.
Abstract
Many stroke survivors, despite improvements in mortality and morbidity, remain dependent on others for everyday activities. People with stroke need access to effective specialist multidisciplinary rehabilitation services that are organised and integrated within the whole system of health and social care. They also commonly come under the care of generalists in various clinical contexts, including intercurrent illness. This Clinical Medicine Concise Guideline abstracts key recommendations from the National Institute for Health and Care Excellence Clinical Guideline 162 on stroke rehabilitation of p...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Dworzynski K, Ritchie G, Playford ED Tags: Clin Med Source Type: research
Diabetes in older people.
Abstract
OVERVIEWThe management of diabetes in older people is often challenging and poorly researched. The prevalence of cognitive impairment, chronic kidney disease and other co-existing comorbidities increase with age and have a significant impact on glycaemic control targets and treatment options. This conference examined current clinical practice, highlighted differences in the management of diabetes in the older person and suggested potential areas of future research.
PMID: 26430187 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Bennett K Tags: Clin Med Source Type: research
Acute liver failure.
Abstract
Acute liver failure (ALF) is a rare critical illness with high mortality whose successful management requires early recognition and effective initial management. Though it may result from a wide variety of causes, in the UK and much of the developed world most cases result from paracetamol-induced hepatotoxicity, and administration of antidotal N-acetyl cysteine at first recognition is key. Involvement of local critical care services should occur at an early stage for stabilisation, monitoring and supportive care with parallel discussion with specialist liver centres to identify those patients who...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Blackmore L, Bernal W Tags: Clin Med Source Type: research
Management of acute severe ulcerative colitis (NICE CG 166).
Abstract
Ulcerative colitis (UC) presents as an acute severe flare in 10-15% of new cases and it occurs in 15% of patients with established disease. Acute severe UC can lead to significant morbidity and mortality in predominantly younger patients without other comorbidities. Inpatient hospital admission and a multidisciplinary approach are vital in appropriate and timely management. Important but simple aspects in the initial work-up and treatment of such patients are frequently overlooked during the acute medical take. An overview of the general and more specialist management of this important presentatio...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Macken L, Blaker PA Tags: Clin Med Source Type: research
Acute oesophageal symptoms.
Abstract
Acute oesophageal symptoms include acute dysphagia or food bolus impaction (most commonly due to strictures, Schatzki ring and eosinophilic oesophagitis), acute chest pain with odynophagia due to oesophageal infections, motility disorders and acute oesophageal rupture (of which oesophageal intramural haematoma is a subtype). Acute full thickness oesophageal rupture carries a high mortality if not recognised early; the clinical features and conditions with which this may be confused are presented and discussed.
PMID: 26430190 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Hossain SN, de Caestecker J Tags: Clin Med Source Type: research
Acute upper gastrointestinal bleeding.
Abstract
Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered medical emergency with an incidence of 84-160/100000 and associated with mortality of approximately 10%. Guidelines from the National Institute for Care and Care Excellence outline key features in the management of AUGIB. Patients require prompt resuscitation and risk assessment using validated tools. Upper gastrointestinal endoscopy provides accurate diagnosis, aids in estimating prognosis and allows therapeutic intervention. Endoscopy should be undertaken immediately after resuscitation in unstable patients and within 24 h...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Kurien M, Lobo AJ Tags: Clin Med Source Type: research
Acute alcohol toxicity and withdrawal in the emergency room and medical admissions unit.
This article focuses on the management of alcohol intoxication, with particular emphasis on aggressive and possibly violent behaviour; alcohol withdrawal; fitting; and the prevention and treatment of Wernicke's encephalopathy.
PMID: 26430192 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Morgan MY Tags: Clin Med Source Type: research
CME Emergencies in gastroenterology (95278): self-assessment questionnaire.
PMID: 26430193 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Harris A, Chowdhury T Tags: Clin Med Source Type: research
