Clin Med
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Many governments in Europe, either of their own volition or at the behest of the international financial institutions, have adopted stringent austerity policies in response to the financial crisis. By contrast, the USA launched a financial stimulus. The results of these experiments are now clear: the American economy is growing and those European countries adopting austerity, including the UK, Ireland, Greece, Portugal and Spain, are stagnating and struggling to repay rising debts. ⋯ Yet their stories remain largely untold. Here, we argue that there is an alternative to austerity, but that ideology is triumphing over evidence. Our paper was written to contribute to discussions among health policy leaders in Europe that will take place at the 15th European Health Forum at Gastein in October 2012, as its theme 'Crisis and Opportunity - Health in an Age of Austerity'.
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Myocardial infarction (MI) and stroke are common acute conditions that regularly present as an emergency to hospital. Paradoxical embolism is a recognised complication of patent foramen ovale (PFO), and the literature shows that it can cause ischaemic stroke or, less frequently, acute MI. Ischaemic stroke and MI occurring simultaneously has a wide differential diagnosis, which should include a PFO, especially when occurring in young patients.
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Acute kidney injury (AKI) is associated with increased patient morbidity and mortality, and represents a significant financial burden for the NHS. The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD)'s report, Adding insult to injury, demonstrated that only 50% of patients who died from AKI received good care and 30% of patients had predictable and avoidable AKI. ⋯ The tips emphasise the importance of good basic medical care and the need for engagement with patients, healthcare professionals and hospital processes. The implementation of these tips in hospitals across the UK could potentially improve patient outcomes and reduce associated costs.
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Here we report on an audit performed to examine compliance with National Institute for Health and Clinical Excellence (NICE) guidelines for the use of anti-tumour necrosis factor alpha (anti-TNFalpha) in treating patients with ankylosing spondylitis (AS). Data from 17 rheumatology centres across the Midlands were collected prospectively from patients with AS attending outpatient clinics and retrospectively in patients receiving anti-TNFalpha but not attending outpatient clinics during the audit. In total, 80% of the 416 patients for whom data were collected were male. ⋯ After anti-TNFalpha treatment had started, regular 12-weekly assessments occurred in 46% of patients. Therefore, compliance with NICE guidance was found to vary among centres. Based on our audit, clinical capacity, and clinical or patient choice might be influencing the suboptimal adherence seen in assessment timing suggested by NICE guidelines relating to the use of anti-TNFalpha in treating patients with AS.
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Case Reports
Ulcerative colitis presenting as pyrexia of unknown origin (PUO) without bowel symptoms.
Ulcerative colitis (UC) can rarely present with fever but it is unusual for it to be devoid of gastrointestinal symptoms. We report a case of UC that presented without bowel symptoms; fever being the only clinical feature. This case highlights the importance of considering UC as a cause of pyrexia of unknown origin (PUO) even in the absence of the lower gastrointestinal features commonly associated with this pathology. It is important to recognise this association as the incidence of UC is increasing in the older population.