Clinical medicine (London, England)
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Patients with multimorbidity are increasingly encountered, especially with an ageing population and the co-segregation of lifestyle diseases such as diabetes, obesity and hypertension, but the care of these patients is fragmented and research rarely undertaken within this group. Research into genetic biomarkers and the evolution of crosscutting multiorgan science, resulting in collaboration between specialties for the treatment of patients with multimorbidity, should be the next major step change in medicine. ⋯ However, there is a necessity to instigate more collaborative multispecialty research efforts to provide the evidence needed to move treatment possibilities forward, leading to the capability for a major redesign of clinical practice. The patient must be at the centre of a new, radically changed and holistic journey and collaborative research with primary care is essential, as general practitioners and primary care colleagues are the experts dealing with common multimorbidities, including those due to long-term poor lifestyle.
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Neurosyphilis is a broad term used to describe an infection caused by Treponema pallidum in the central nervous system. While this was a common cause of stroke in the 19th century, it saw a decline after the introduction of penicillin. However, in the recent past, there has been an increase in the incidence of syphilis, especially with HIV coinfection. ⋯ We describe the case of a 39-year-old man displaying acute global aphasia and right-sided facial weakness in keeping with a left middle cerebral artery infarct. This was confirmed with computed tomography of the brain, and subsequently, further investigations revealed a diagnosis of neurosyphilis. The patient was treated with intravenous benzylpenicillin and recovered well with treatment.
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The UK National Institute for Health and Care Excellence (NICE) updated its guidelines on stable chest pain in 2016 and recommended computed tomography coronary angiography (CTCA) as first line investigation for all patients with new onset symptoms. We implemented the guideline and audited downstream testing. ⋯ CTCA was an effective rule-out test for most patients. In patients that went on to have ICA, the overall yield of severe CAD was relatively high. This compares well with our previous audit applying the NICE 2010 guidelines which recommended ICA for all high probability patients wherein the yield of severe CAD was 30%.
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We aimed to describe and evaluate the National Early Warning Score (NEWS) in the 24 hours preceding an in-hospital cardiac arrest among general somatic ward patients. The 24 hours preceding the in-hospital cardiac arrest were divided into four timespans and analysed by a medical record review of 127:254 matched case-control patients. ⋯ The NEWS high-risk category was associated with an increase of 3.17 (95% confidence interval (CI) 1.66-6.04) to 4.43 (95% CI 2.56-7.67) in odds of in-hospital cardiac arrest compared to the low-risk category. NEWS, with its intuitive and for healthcare staff easy to interpret risk classification, is suitable for discriminating deteriorating patients with major deviating vital signs scoring high risk on NEWS.
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Early warning scores (EWS) generated in a developed healthcare setting may not perform as well in low-resource settings in sub-Saharan Africa. ⋯ There were only marginal and no statistical differences in the performance of EWS generated in low- and high-resource healthcare settings in a cohort of unselected acutely ill medical patients admitted to a low-resource hospital in sub-Saharan Africa.