Clin Med
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Historically, acute medical staffing numbers have been lower on weekends and in winter numbers of medical admissions rise. An analysis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions to Portsmouth Hospitals over a seven-year period was undertaken to examine the effects of admission on a weekend, of winter, and with the opening of a medical admissions unit (MAU). In total, 9,915 admissions with AECOPD were identified. ⋯ After opening the MAU, the OR for death day 1 after weekend winter admission fell from 3.63 (95% CI 1.15 to 11.5) to 1.65 (95% CI 0.14 to 19.01). AECOPD patients have an increased risk of death after admission over a weekend in winter and this effect was reduced by opening a MAU. These findings have implications for the planning of acute care provision in different seasons.
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Case Reports
Misdiagnosis: analysis based on case record review with proposals aimed to improve diagnostic processes.
Diagnostic error underlies about 10% of adverse events occurring in hospital practice. However, there have been very few studies considering means of improving the mechanisms of diagnosis. As a result, misdiagnosis has been described as 'the next frontier for patient safety'. ⋯ These observations led to the proposal of a clinical assessment with a method designed to encourage analytical reasoning. In addition, minor defects in standard practice are shown to adversely influence diagnosis. The findings of this study offer possible means of improving the quality of diagnosis and subsequent patient care, and perhaps pave the way for prospective studies.
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The incidence and prevalence of diabetes mellitus (DM) is rapidly increasing across the globe. Tuberculosis (TB), meanwhile, remains a significant problem in low and middle income countries fuelled by high rates of HIV/AIDS. This article explores the long recognised but underappreciated connection between the two, revealing that DM makes a substantial contribution to the burden of incident TB around the world and may also worsen TB severity and treatment outcome. The dual management of the diseases may be challenging but must be addressed, both in low and high income settings, because the rising worldwide diabetes burden poses a threat to global TB control.
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Carotid artery dissection is an important cause of stroke in young adults. When focal neurological deficit or classic traumatic history is absent, the diagnosis can be challenging. This lesson reports an interesting case of a patient in whom pupillary dysfunction was the presenting sign of acute dissection of carotid artery.
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The aim of this study was to audit cardiac arrest documentation within a UK teaching hospital, survey the regional use of proformas for data collection, and consider the need for a standardised national template. A prospective audit comparing cardiac arrest documentation to General Medical Council (GMC) professional standards and the 'Utstein' fields was carried out, along with a survey of regional resuscitation officers for the use of standardised templates. The main outcome measures were the design of 'best practice' template using GMC guidelines and the 'Utstein' fields. ⋯ There was limited documentation concerning process, events and outcome of arrest calls, as well as minimal regional use of standard templates or consensus on the essential content of medical documentation. Documentation of cardiac arrests in the Leeds Teaching Hospitals does not meet the 'Utstein' recommendations to provide enough information for audit of cardiac arrest procedure. The regional survey indicates that this problem is likely to be widespread.