Clinical medicine (London, England)
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Increasing rates of liver transplantation and improved outcomes have led to greater numbers of transplant recipients followed up in non-transplant centres. Our aim was to document long-term clinical outcomes of liver transplant recipients managed in this 'hub-and-spoke' healthcare model. ⋯ Adopting a new model of healthcare provides a means of delivering post-transplant patient care close to home without compromising patient survival and long-term clinical outcomes.
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Fibromyalgia and myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) are poorly understood conditions with overlapping symptoms, fuelling debate as to whether they are manifestations of the same spectrum or separate entities. Both are associated with hypermobility, but this remains significantly undiagnosed, despite impact on quality of life. ⋯ Symptomatic hypermobility is particularly relevant to fibromyalgia and ME/CFS, and our findings highlight high rates of mis-/underdiagnosis. These poorly understood conditions have a considerable impact on quality of life and our observations have implications for diagnosis and treatment targets.
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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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Case Reports
Rhabdomyolysis with acute anuria renal failure caused by surgical injection-induced tetanus in an adult.
Tetanus is a rapidly progressive infection characterised by painful spasms and muscular rigidity with a series of complications including airway obstruction, respiratory failure, pulmonary infection, heart arrhythmias and acute kidney injury. Rhabdomyolysis with acute anuria renal failure is rarely reported as a complication in tetanus. We present a case of an adult who suffered from rhabdomyolysis combined with acute anuria renal failure caused by surgical injection-induced tetanus. ⋯ The patient fully recovered and was discharged from hospital 5 weeks after admission. Good bowel preparation is an important prerequisite for preventing tetanus in a haemorrhoids operation. Effective control of muscle spasms with neuromuscular blockers and early administration of haemoperfusion plus CVVH are vital to the treatment of tetanus-induced rhabdomyolysis with acute renal failure.
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Antibiotic use drives antibiotic resistance. Reducing antibiotic use through reducing antibiotic course lengths could contribute to the UK national ambition to reduce total antibiotic use. ⋯ Clinical application of the evidence-based guidance for shorter antibiotic course lengths appears to be a valid strategy for reducing total antibiotic consumption.