Clin Med
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Fever of unknown origin (FUO) is an entity caused by more than 200 diseases. Haematologic neoplasms are the most common malignant cause of FUO. Fever as a first symptom of colonic tumour pathology, both benign and malignant, is a rare form of presentation. ⋯ Coagulase-negative staphylococci were the most common cause of bacteraemia. Nine of 10 faecal occult blood tests performed were positive. Fever secondary to colon neoplasms, both benign and malignant, usually presents with a bacteraemic pattern, with positive results for blood-culture tests in a high percentage of cases.
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The myeloproliferative neoplasms that are associated with the JAK2 mutation are a heterogeneous group of disorders. The additional mutations that result in the clinical phenotype are still the subject of research. ⋯ Although new drugs are being developed, treatment at present is predominantly with agents that have been in use for many years. An understanding of the need to control the thrombotic risk has, however, led to improved survival rates such that ET and PV can be seen as chronic diseases.
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Comparative Study
Introducing physician assistants into an intensive care unit: process, problems, impact and recommendations.
The National Health Service (NHS) is facing substantial staffing challenges arising from reduced working hours, fewer trainees and more protected training of those trainees. Although increasing consultant-delivered care helps to meet these challenges, there remains a need to remodel the workforce. One component of the solution is physician assistants (PAs), who are professionals trained in patient assessment and care, working under the supervision of trained doctors. ⋯ When surveyed at 10 months, PAs were undertaking most PICU procedures, albeit with some supervision. The study shows that PAs can be a valuable addition to the medical workforce, but that predictable problems can mar their introduction. Solutions are suggested for other units intending to follow this model.
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The misdiagnosis of MND (particularly of the ALS phenotype), is uncommon. Atypical presentations, particularly of focal onset and with pure LMN or UMN signs, present a more difficult diagnostic challenge, although perhaps reassuringly, treatable mimics are rare. A working knowledge of potential alternative conditions and MND diagnostic pitfalls should help to reduce the misdiagnosis rate, particularly if the key points are considered.