Clinical medicine (London, England)
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Allergen-specific immunotherapy (AIT) has been used to treat allergic diseases for over a century. It is the only treatment that addresses immune dysfunction underlying allergic responses rather than simply treating symptoms or suppressing inflammation. Its safety and efficacy in allergic rhinitis, asthma and insect allergy has been documented in a number of systematic reviews but its cost effectiveness is less clear. ⋯ AIT is used widely in western Europe and the USA. In the UK, subcutaneous immunotherapy is often used for bee and wasp allergy, while both subcutaneous and sublingual immunotherapies are used for severe allergic rhinitis and occasionally for house dust mite and pet allergies. In conclusion, AIT is safe and effective and should be considered as a treatment option for those with allergic diseases.
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Each year in the UK, it is estimated that more than 100,000 people are admitted to hospital with sepsis and around 37,000 people will die as a result of the condition. We present an audit, re-audit and the implications these have had on the management of severe sepsis using the Sepsis Six, ultimately through actively promoting teamwork to initiate the protocol. This led to a significant improvement in management, decreasing admissions to the intensive care unit (ITU), length of stay in hospital and the number of patient deaths. ⋯ Initially, 19% were admitted to the ITU (6% died), improving to 7% on re-audit (with no deaths). Length of hospital stay reduced from 10 to 7 days (p<0.0001). There was a complete change in the management of severe sepsis with trust-wide updated protocols, resulting in a decrease in hospital morbidity and mortality.
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Breast cancer diagnosed during pregnancy is a relatively uncommon event. This challenging situation presents clinicians with difficult decisions, often requiring a multidisciplinary approach at a time of heightened anxiety for the patient and their family. This paper describes the case of a young woman with metastatic breast cancer diagnosed in early pregnancy, and outlines how this complex clinical situation was managed.
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Drug allergy is defined as an adverse drug reaction with an established immunological mechanism. The National Institute for Health and Care Excellence published clinical guidelines on drug allergy in 2014 and quality standards in 2015. The intention of this article is to highlight indications for referral to specialists for management of drug allergy. ⋯ However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. It is, therefore, important to highlight to general physicians and physicians of other specialties, those patients who do require referral for specialist review.
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Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. ⋯ Stressors include direct insults to the brain, insults peripheral to the brain or external changes in the environment of an individual. Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types.