Lesson of the month 1: A cough that doesn't fit the mould.
Abstract
Aspergillus disease has a wide spectrum of manifestations within the lungs; however invasive Aspergillus is most commonly associated with immunocompromise or pre-existing respiratory disease. Here we present a case of Aspergillus tracheobronchitis causing right middle lobe collapse, masquerading as late-onset asthma in a patient with no pre-existing risk factors following massive inhalation of Aspergillus spores from working with compost. This case highlights the importance of having a high index of suspicion for Aspergillus-related disease even in those with no traditional risk factors.
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Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Baggott C, Sharp C, Bhatt N, Plummeridge M, Adamali H Tags: Clin Med Source Type: research
Lesson of the month 2: An unusual presentation of hyperinsulinaemic hypoglycaemia with possible underlying diagnosis of glucose-sensitive insulinoma or islet cell hyperplasia.
Abstract
Postprandial hypoglycaemia can occur in islet cell hyperplasia and in reactive hypoglycaemia. Less commonly, it can occur with insulinoma. A case is described where the differential diagnosis was glucose-sensitive insulinoma or islet cell hyperplasia. Typical provocation was prolonged exertion or fasting followed by ingestion of sugary snacks resulting in hypoglycaemic seizures and collapse. Biochemistry and computerised tomography imaging were consistent with an insulinoma in the pancreatic tail, but this was not confirmed on endoscopic ultrasound. Selective intra-arterial calcium stimulation wit...
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Maguire D Tags: Clin Med Source Type: research
Image of the month: Chest pain after cocaine use.
PMID: 26430196 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Bond R, Duncan E, Nightingale A Tags: Clin Med Source Type: research
Letters to the editor.
PMID: 26430197 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Buss L, Hurst JR Tags: Clin Med Source Type: research
Letters to the editor.
PMID: 26430198 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Aston I, Heron R Tags: Clin Med Source Type: research
Impact of stroke services on geriatric medicine in Wales.
Abstract
OverviewLetters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references.
PMID: 26430199 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Adhiyaman V, Chattopadhyay I Tags: Clin Med Source Type: research
On-going lessons in fluid prescription: assessment of adherence to weight-based intravenous fluid prescribing in medical inpatients.
Abstract
OVERVIEWLetters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references.
PMID: 26430200 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 4, 2015 Category: Journals (General) Authors: Cocker D, Sloane D, Carlin F, Marks E, Beadsworth M Tags: Clin Med Source Type: research
Choosing wisely - choosing tactics.
PMID: 26407376 [PubMed - as supplied by publisher] (Source: Clinical Medicine)
Source: Clinical Medicine - August 1, 2015 Category: Journals (General) Authors: Hodgson H Tags: Clin Med Source Type: research
Recruitment to non-procedural specialties.
PMID: 26407377 [PubMed - as supplied by publisher] (Source: Clinical Medicine)
Source: Clinical Medicine - August 1, 2015 Category: Journals (General) Authors: Gordon H Tags: Clin Med Source Type: research
Deciding when physicians are unfit to practise: an analysis of responsibilities, policy and practice in 11 European Union member states.
Abstract
In 1974, the European Economic Community established mutual recognition of medical qualifications obtained in any of its member states. Subsequently, a series of directives has elaborated on the initial provisions, with the most recent enacted in 2013. However, greater movement of physicians across borders and some high-profile scandals have raised questions about how to prevent a physician sanctioned in one country from simply moving to another, without undermining the principle of free movement. A survey of key informants in 11 European Union (EU) member states was supplemented by a review of pe...
Source: Clinical Medicine - August 1, 2015 Category: Journals (General) Authors: Struckmann V, Panteli D, Legido-Quigley H, Risso-Gill I, McKee M, Busse R Tags: Clin Med Source Type: research
The influence of a simple blood transfusion policy on overtransfusion in acute upper gastrointestinal haemorrhage .
This study reports the impact of introducing a simple cross-match policy in a district general hospital, which resulted in a substantial fall in the prevalence of overtransfusion (odds ratio 0.43; 95% confidence interval 0.19-0.98), with potential patient benefits in terms of rebleeding, and a reduction in the total blood transfused from 162 to 121 units per 100 patients with AUGIH. For the cost of blood alone, this corresponds to projected savings across the NHS in England in excess of £2 million per annum.
PMID: 26407379 [PubMed - as supplied by publisher] (Source: Clinical Medicine)
Source: Clinical Medicine - August 1, 2015 Category: Journals (General) Authors: Stokes A, Thompson C, Clegg A, Snook J Tags: Clin Med Source Type: research
The direct cost of intravenous insulin infusions to the NHS in England and Wales.
In this study, the direct costs of intravenous insulin infusions to the NHS in England and Wales have been estimated to vary from £6.4-8.5 million in the first 24-hour period on infusion. More appropriate use of these infusions could result in substantial cost savings.
PMID: 26407380 [PubMed - as supplied by publisher] (Source: Clinical Medicine)
Source: Clinical Medicine - August 1, 2015 Category: Journals (General) Authors: Rajendran R, Scott A, Rayman G Tags: Clin Med Source Type: research
Physical restraint and the protection of the human rights of immigration detainees in hospitals.
Abstract
Immigration detainees, like prisoners, are entitled to the same standard of healthcare as non-detained patients. When hospital attendance or admission is required, the priority for custodial staff (who for purposes of this article we refer to as 'escorts') is to prevent absconding. For that reason, they may wish to use physical restraints, such as handcuffs, and remain with the detainee at all times. This can be degrading for the patient and breach their human rights. Clinicians have professional obligations to all their patients and must object to any restraint methods that risk damaging the pati...
Source: Clinical Medicine - August 1, 2015 Category: Journals (General) Authors: Pickles H, Norton E, Ginn E, Schleicher T Tags: Clin Med Source Type: research
Systematic review on the prevalence of lack of capacity in medical and psychiatric settings.
Abstract
Recent court cases in England and Wales have refocused attention on patients' decision-making capacity to consent. Little is known about the prevalence of incapacity across specialities but decision-making capacity is likely to be overestimated by clinicians. The aim of this systematic review is to estimate the prevalence of incapacity to consent to treatment or admission in different medical and psychiatric settings, and compare the two. We conducted an electronic search following PRISMA principles and included 35 studies in psychiatric and 23 studies in medical settings. The 58 included studies ...
Source: Clinical Medicine - August 1, 2015 Category: Journals (General) Authors: Lepping P, Stanly T, Turner J Tags: Clin Med Source Type: research
Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options.
Abstract
Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ≥15 headache days per month for ≥3 months, in which ≥8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. Chronic migraine is associated with a higher burden of disease, more severe psychiatric comorbidity, greater use of healthcare resources, and higher overall costs than episodic migraine (<15 head...
Source: Clinical Medicine - August 1, 2015 Category: Journals (General) Authors: Diener HC, Solbach K, Holle D, Gaul C Tags: Clin Med Source Type: research
