Irish journal of medical science
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Replacement of thyroid hormones (TH) with Levothyroxine (LT4) is the treatment of choice for hypothyroidism, however, there are aspects of treatment where uncertainties exist and practice varies. Factors influencing initiation and choice of TH replacement may impact patient satisfaction, safety, and health care costs. ⋯ LT4 tablets are the treatment of choice for hypothyroidism in Ireland. Approximately a third of Irish endocrinologists either regularly use, or would consider, liothyronine for hypothyroid patients. A significant proportion would give TH to euthyroid individuals in specific circumstances. The prescription of TH amongst Irish endocrinologists was generally in keeping with recommended practice, and areas where practice deviated from guidance were typically where evidence was conflicting or insufficient.
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Review Case Reports
This infant is having a stroke: an illustrative case report.
Paediatric stroke is a rare event, and timely intervention is required to minimise long-term disability, reduced quality of life and financial implications. Although reperfusion strategies such as thrombolysis and thrombectomy are now well established in the adult population, and paediatric consensus guidelines allow for reperfusion therapies in children, access is currently limited due to diagnostic delays. This challenge is partly due to the rarity of presentation, infrastructure and public awareness to support early diagnosis as exists in the adult setting. We use an illustrative case and literature to describe an achieved case of paediatric stroke within an Irish setting. ⋯ Paediatric stroke care should be available to all children presenting with acute stroke symptoms; however, the rarity of the diagnosis would suggest a national strategy will be required to provide equitable care at a national level.
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To provide safe and effective patient care, records must be kept in a high-quality manner. Clinical audits should be conducted on a frequent basis to ensure that high standards of record-keeping are upheld. An audit and re-audit of the surgical inpatient records' documentation were conducted as part of a retrospective, descriptive study to see if it aligns with the hospital's stated policy. ⋯ Record-keeping must be considered as an integral part of medical practice; current documentation work demonstrates that when performed appropriately, audit can actually affect the quality of clinical records. The audit itself can increase awareness of the need for practice improvement. The distribution of findings, instruction, training, and local action planning are all essential for developing practice.
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Sodium-glucose transporter 2 (SGLT-2) inhibitors provide additional benefits besides glycemic control. ⋯ Dapagliflozin and empagliflozin are the drugs to choose for renoprotection in diabetics independent of the use of a RAAS blocker. Even the time to addition of a new anti-diabetic agent is longer in the empagliflozin group, head-to-head comparative trials are needed to asess the potential differences in this regard.