Clinical medicine (London, England)
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Serious incident (SI) investigations aim to identify factors that caused or could have caused serious patient harm. This study aimed to use the Human Factors Analysis and Classification System (HFACS) to characterise the contributory factors identified in SI investigation reports. ⋯ Analysis of SI investigation reports using a modified HFACS framework allows important insights into what investigators view as contributory factors. We found an emphasis on human error but little engagement with why it occurs. Better investigations will require independence and professionalisation of investigators, human factors expertise, and a systems approach.
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As the COVID-19 pandemic continues to evolve, different clinical manifestations are better understood and studied. These include various haematologic disorders that have been shown to be associated with increased morbidity and mortality. We studied the prevalence of one unusual manifestation, heparin-induced thrombocytopenia (HIT) and its clinical implications in patients who are severely ill with COVID-19 in a single tertiary centre in Israel. ⋯ Platelet abnormalities and HIT are common in patients who are critically ill with COVID-19 and are associated with the worst clinical outcomes. The mechanisms underlying HIT in COVID-19 are yet to be studied; HIT may contribute to the dysregulated immunologic response associated with COVID-19 critical illness and may play a significant part in the coagulopathy seen in these patients. As many patients with COVID-19 require aggressive thromboprophylaxis, further understanding of HIT and the implementation of appropriate protocols are important.
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Accurately predicting risk of patient deterioration is vital. Altered physiology in chronic disease affects the prognostic ability of vital signs based early warning score systems. We aimed to assess the potential of early warning score patterns to improve outcome prediction in patients with respiratory disease. ⋯ Combining the most recently recorded score and the maximum NEWS2 score from the preceding 24 hours demonstrated greater accuracy than using snapshot NEWS2. This simple inclusion of a scoring pattern should be considered in future iterations of early warning scoring systems.
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We were aware of high numbers of inpatients unvaccinated against COVID-19 at Guy's and St Thomas' NHS Foundation Trust (GSTT). Due to this, an inpatient vaccination protocol was set up in July 2021, with initially limited uptake. ⋯ An improved pathway and referral process increased the number of inpatient vaccinations delivered. Further work is required in order to ensure that more patients who have been referred are vaccinated.
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Case Reports
Continuous glucose monitoring for diabetes: potential pitfalls for the general physician.
A 31-year-old man presented systemically unwell with diabetic ketoacidosis (DKA). He was using an intermittently scanned continuous glucose monitoring (CGM) device that had been recording low or normal glucose readings for the 48 hours prior to admission. The sensor site had become infected, and we believe this soft tissue infection caused his CGM device to record falsely low glucose readings leading the patient to erroneously lower his insulin doses and take extra carbohydrates, precipitating DKA. ⋯ When interstitial glucose readings do not match symptoms or expectations, a capillary blood glucose reading should be taken to correlate and impact treatment decisions. There will be an increase in patients presenting to hospital with CGM devices as the National Institute for Health and Care Excellence guidelines have recently been updated. We use this interesting clinical case to provide context for key learning points about CGM devices for the general physician.