Clinical medicine (London, England)
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A cohort of the first 50 COVID-19 patients in East Tyrol, a region in the southwest of Austria, were monitored in home quarantine. Specific viral ribonucleic acid was detected in throat swabs and stool samples. Analysis indicated a median virus shedding duration of 13 days; however, statistical outliers highlight the importance of consequent testing. ⋯ Investigation revealed seven relapses and viral shedding fluctuation in four cases. A follow-up examination shed light on seroconversion which could be observed in 35 of 40 participants. This further clarifies the necessity of establishing discharge standards and follow-up management for COVID-19 patients.
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The indiscriminate use of antibiotics in clinical practice may be an independent risk factor for the development of antimicrobial resistance. To combat this, our hospital implemented a hospital antibiotic policy which outlines the appropriate antibiotic to be used in an acute admission, based on a continuously updated local antibiogram. ⋯ We show that a simple QIP model combined with the use of a mobile application can serve to improve compliance even in a low-resource setting with minimum infrastructure. This model could be easily extrapolated into similar settings.
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Normal baseline investigation results in a patient with common symptoms is often labelled as being due to a functional disorder, with all the pejorative connotations that go along with that term. When given the opportunity to see a patient for a second opinion, it is important to retain an open mind rather than assuming previous assessments are correct. Such an attitude helps with both attaining the definitive diagnosis but is also crucial to helping give hope to the patient. Understanding the patient's concerns about the meaning of their symptoms is critical in finding the balance between advanced investigation to identify a putative cause versus a decision to proceed with symptomatic control.
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We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, and 'scan-negative' cauda equina syndrome. ⋯ We recommend that patients with FND are referred to specialists with expertise in neurological diagnosis. FND is a common presentation in emergency and acute medical settings and there are many practical elements to making a positive diagnosis and communication which are useful for all physicians to be familiar with.