Clin Med
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This lesson reports the case of endophthalmitis, a rare presentation of infective endocarditis (IE), two months following cardiac surgery. Although inflammatory markers were increased, blood cultures were negative. Transoesophageal echocardiography demonstrated an aortic root abscess. Culture of tissue obtained at surgery revealed the infective organism to be Aspergillus fumigatus, a rare cause of IE in the immunocompetent patient.
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The impact of twice-daily consultant ward rounds on the length of stay in two general medical wards.
Excess average length of stay (ALoS) not only results in an increased cost to hospitals but also increases the risk of hospital-acquired infection and thromboembolism. Various factors suggested to affect ALoS have yet to demonstrate a significant impact in clinical practice. Increased consultant input has been identified as an important factor influencing ALoS. ⋯ The number of discharges (NoDs) significantly increased (p < 0.01), ALoS reduced (p < 0.01), whereas, readmission rate and mortality remained unchanged (p = NS) over 12 months following twice-daily WRs compared to two other wards with twice-weekly WRs. This innovative model resulted in almost doubling the NoDs and halving the ALoS. This study suggests that ALoS can be reduced and sustained with a cultural and behavioural shift in consultant working patterns, without affecting readmission rate or inpatient mortality.
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Case Reports
Lesson of the month (1). Homonymous left hemianopia secondary to traumatic extracranial vertebral artery dissection.
This lesson reports the case of a 32-year-old female presenting with left-sided homonymous hemianopia after a road traffic accident. A diagnosis of vertebral artery dissection (VAD) was missed at presentation after an initial computed tomography head scan was normal. Later, VAD was confirmed on neck magnetic resonance imaging. VAD is an uncommon cause of stroke in the young and, to date, there are no current emergency guidelines available for the management of patients with the condition.