Clinical medicine (London, England)
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Patient and professional views about the impact of providing full real-time access to the medical record in the in-hospital setting are unknown. ⋯ The current system of providing information verbally to patients is inadequate. Patients want more information and are less concerned than physicians about potential negative effects of real-time access to their records. Patient access to medical records (in both full and summary forms) should be evaluated.
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Diabetic ketoacidosis (DKA) is not a rare presentation to hospital, despite being an entirely preventable condition. A concerning number of people also develop DKA while already in hospital. Management of DKA has changed in the last decade, and national guidelines introduced, to help standardise care, spread best practice, and reduce mortality and morbidity.
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There are about 4.7 million people living with diabetes mellitus in the UK and 90% have type 2 diabetes mellitus (T2DM). This burden will only get worse as there are currently about 12.3 million more at risk of T2DM. ⋯ Atherosclerotic cardiovascular disease (ASCVD), the leading cause of death in diabetes, contributes significantly to this. Therefore, there is significant emphasis on the prevention of T2DM especially in at-risk groups with the setting up of initiatives like the Diabetes Prevention Programme. When prevention fails, it is essential to commence glucose-lowering agents to reduce the burden of disease, prevent associated complications and improve quality of life. A patient-centred approach is required to ensure efficacy of treatment strategies and the presence of co-morbidities such as cardiovascular and renal disease should be considered.
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Case Reports
Guillain-Barré syndrome presenting with an 'angina' mimic and posterior reversible encephalopathy syndrome.
A 56-year-old woman presented with severe headache, blurring of vision, hypertensive emergency and severe crushing central chest pain. Extensive evaluation was undertaken to rule out sinister myocardial, pulmonary and mediastinal pathology. ⋯ Nerve conduction studies confirmed a demyelinating Guillain-Barré syndrome. Intravenous immunoglobulin treatment led to rapid resolution of pain, dysautonomia and neuropathic symptoms.