The journal of the Royal College of Physicians of Edinburgh
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Despite global efforts to reduce maternal mortality, maternal deaths from bacterial sepsis have actually risen in the UK. The group A streptococcus, also known as Streptococcus pyogenes, is the leading cause of infection-related death in pregnancy and the puerperium. ⋯ Here, the epidemiology, aetiology, and management of severe peripartum sepsis are discussed, as are potential approaches to reduce risks. While fundamental changes in healthcare access can lead to dramatic reductions in maternal deaths in developing countries, an improvement in maternal sepsis deaths in the UK will require heightened awareness among both hospital and community-based clinical staff.
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J R Coll Physicians Edinb · Dec 2011
Implementing Surviving Sepsis guidelines in a district general hospital.
We describe efforts made at Blackpool Victoria Hospital to implement the well-established international Surviving Sepsis guidelines. These included posters, pocket guides and stickers inserted in patient notes. All doctors and nurses in acute areas received specific information and education. ⋯ Cases were considered prospectively at the time of initial assessment and 198 patients were identified; 169 (85%) had blood cultures taken; 146 (74%) had lactate levels measured; and 145 (74%) received antibiotics within the target time. We believe these results demonstrate relatively effective implementation of guidelines in the challenging environment of a district general hospital. Our results could be replicated easily and provide a good way of reducing patient mortality at minimal financial cost.
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J R Coll Physicians Edinb · Dec 2011
Evaluation of the use of venous thromboembolism prophylaxis in hospitalised medical patients.
Venous thromboembolism (VTE) prophylaxis is effective in the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in medical patients. ⋯ The provision rate of pharmacological VTE prophylaxis in hospitalised medical patients who met pre-defined clinical criteria for prophylaxis was 54%. The rate of prophylaxis increased with additional VTE risk factors to a peak rate of 67%. There is room for the development of strategies to improve the use of VTE prophylaxis in hospitalised medical patients.
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J R Coll Physicians Edinb · Dec 2011
Biography Historical ArticleDr Roger McNeill and public health in the Highlands and islands of Scotland.
Roger McNeill was born in 1853 on Colonsay in the Inner Hebrides, the son of a cattle herder. He graduated with a degree in medicine from Edinburgh University, where he studied with Joseph Lister, among others. After working in London during a smallpox epidemic, he received a gold medal and honours for his M. ⋯ His was an illustrious yet understated career in public health: he was the first president of the Caledonian Medical Society (1881-82), he earned a Diploma in Public Health from Cambridge University (1889), he was the first Medical Officer of Health for Argyll (1890-1924), wrote The Prevention of Epidemics and the Construction and Management of Isolation Hospitals (1894), and was the first witness before Parliament's Dewar Committee in Oban in 1912. McNeill and other members of the Caledonian Medical Society testified about medical services in remote Scotland, encouraging a revolution in healthcare throughout the Highlands and Islands. The committee's report led to the foundation of the Highlands and Islands Medical Service, a forerunner of the National Health Service established in 1948.
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It is widely established that vitamin D is critical for bone health. There is also an increasing body of evidence from observational studies that low levels of vitamin D are associated with a range of other disorders, including cancer and cardiovascular disease. ⋯ The key question is whether there is sufficient evidence to justify supplementing vitamin D intakes for all. In this 'Controversy in Medicine', two international experts argue the case 'for' and 'against' universal vitamin D supplementation.