Clinical medicine (London, England)
-
Case Reports
Lessons of the month 1: Salbutamol induced lactic acidosis: clinically recognised but often forgotten.
We present the case of an 83-year-old woman, with known asthma, admitted with increasing dyspnoea, wheeze and a productive cough. In addition to maintenance inhaled therapy, the patient was also on long-term mirtazapine and furosemide. ⋯ This clinical scenario is common but not well described. Here we discuss the mechanisms, investigation and management of raised serum lactate and lactic acidosis in the context of acute asthma and the possible interactions of polypharmacy and comorbidities in the acute medical setting.
-
During transition from children's to adults' healthcare, young adults with long-term conditions may show delays in psychosocial development compared to their peers without long-term conditions, and deterioration of their conditions' medical control. ⋯ There is an important role for funders (commissioners) of adults' services to fund transitional healthcare, in addition to funders of children's services who currently take responsibility.It is important that healthcare provider organisations adopt an organisation-wide approach to implementation to ensure that good practice is adopted in children's and adults' services, not just adopted by enthusiasts in some specialties. This includes provision of 'developmentally appropriate healthcare' which recognises the changing biopsychosocial developmental needs of young people.Three features of transitional healthcare were associated with improved outcomes: appropriate parent involvement, promotion of young people's confidence in managing their health and meeting the adult team before transfer. These should be maintained or introduced as a priority.Child and adult healthcare providers should routinely explore with a young person how they approach transition and personalise their clinical approach thereafter.These implications are relevant for a range of stakeholders, including funders of transitional healthcare, organisations providing transitional healthcare and clinical practitioners.
-
Observational Study
Integrating mental and physical health assessment in a neuro-otology clinic: feasibility, acceptability, associations and prevalence of common mental health disorders.
People with persistent physical symptoms are at risk of psychological symptoms, although recognition in medical settings is low. This is a retrospective observational study of 954 patients in a hospital outpatient neuro-otology clinic in order to assess the feasibility and acceptability of an electronic informatics system for collection of patient-reported outcomes, with real-time feedback to guide clinical care and describe the prevalence of anxiety and depressive symptoms. The proportion of patients successfully completing the screen was high (70%). ⋯ Suicidal ideation was present in 5%. Anxiety and depression were highly correlated to dizziness specific outcome measures (p<0.01). Electronic screening is feasible and acceptable to patients and staff in this setting, helping to identify service needs, inform care and monitor outcomes.