Clinical medicine (London, England)
-
In this article, we briefly describe some of the challenges in delivering a stroke service in the NHS in England and how we have overcome them. Current issues are considered and research prospects described. We show that providing excellent stroke care is as much about organising services as it is about medical intervention.
-
Immunoglobulin is an expensive blood product of potentially limited supply used in a wide variety of medical conditions, across a number of specialties. Historically, immunoglobulin has been associated with transmission of blood borne infection (eg hepatitis C). Immunoglobulin use needs to be carefully considered, appropriately prescribed and recorded. The Department of Health, in conjunction with relevant stakeholders, has established a demand management programme to secure immunoglobulin supplies for patients most in need of treatment and to limit use for indications where evidence is lacking.
-
Understanding and learning from hospital deaths is an important component of good clinical practice but current approaches and measures are complex, controversial and difficult to understand. Patients who die are not a homogeneous group but fall into three distinct categories; most learning will be achieved by recognising this and investigating categories of deaths in different ways, relying heavily on qualitative approaches. Numerical measures of overall hospital mortality, such as hospital standardised mortality ratio (HSMR) or measures of 'preventable' deaths, are most unlikely to be helpful at a hospital level and may even give false reassurance, as accuracy of measurement is strongly influenced by factors apart from quality of care.
-
Hip fracture is a prevalent age-associated occurrence incorporating both medical and surgical need and a major challenge to public health and NHS resources. Effective management requires coordinated collaboration across specialties, professions and services. This concise guideline focuses on interdisciplinary aspects of hip fracture management abstracted from National Institute for Health and Care Excellence (NICE) clinical guideline (CG124), including the concept and implementation of the Hip Fracture Programme, detection and management of comorbidity and delirium, optimal analgesia, timing of surgery, multidisciplinary mobilisation, rehabilitation and hospital discharge. The recently updated National Hip Fracture Database report and NICE quality standard are potential drivers for progress.
-
A 19-year-old male with a history of idiopathic panuveitis, currently taking methotrexate and infliximab, presented to our institution with 6 weeks of cough, dyspnoea and fevers. He had failed outpatient antimicrobial therapy. ⋯ Bronchoalveolar lavage was performed with a transbronchial lung biopsy because of the diagnostic uncertainty of the patient's presentation. Pathology revealed non-budding yeasts, consistent with Pneumocystis Serological and urine studies were positive for both Histoplasma and Blastomyces The diagnosis of Histoplasma pneumonia was made because of the presentation being inconsistent with Pneumocystis pneumonia, and serology, urine and pathology testing being more consistent with Histoplasma The patient was treated with oral itraconazole and was doing well at follow-up 12 weeks after hospitalisation.