Postgraduate medical journal
-
Pulmonary arterial hypertension (PAH) is an uncommon condition associated with significant morbidity and mortality. It has diverse aetiology with differing clinical presentations, imaging features and treatments that range from surgical treatment of proximal chronic thromboembolic disease to targeted medical therapies in small vessel disease. Current classification of pulmonary hypertension (PH) is clinically based and groups diseases with similar pathophysiological mechanisms and therapeutic approaches. ⋯ For example, while MRI and echocardiography permit cardiac structural and functional assessment, CT pulmonary angiography provides exquisite morphological information about the proximal pulmonary vasculature and lung parenchyma but little functional information. Modern cross-sectional imaging techniques (CT and MRI) hold the promise of a comprehensive evaluation of the heart, circulation and lung parenchyma in PH. The authors present a multimodality-imaging algorithm for the investigation of patients with suspected PH though it is acknowledged that there is some variation in practice depending on availability of resources and expertise.
-
Current recommendations for the treatment of vitamin D deficiency vary from calciferol 800 IU per day to loading doses of vitamin D followed by maintenance therapy of up to 2000 IU per day. ⋯ We have shown a divergence between clinical practice and even the most conservative expert advice for vitamin D replacement therapy. Possible explanations are conflicting advice on treatment and difficulty obtaining suitable vitamin D preparations, particularly high dose vitamin D and vitamin D without calcium, in the UK.
-
Rapid response systems (RRSs) have been introduced to facilitate effective 'rescue' of seriously ill patients on hospital wards. While research has demonstrated some benefit, uncertainty remains regarding impact on patient outcomes. Little is known about the relationship between social contexts and the application of the RRS. ⋯ Locating a RRS within a pathway of care for the acutely ill patient illustrates the role of these safety strategies within the social organisation of clinical work. There is a need to broaden the focus of inquiry from detection and initiation of escalation (where the strategies are principally directed) towards team response behaviour and towards those medical response practices which to date have escaped scrutiny and monitoring.
-
To evaluate the association between xanthelasma palpebrarum (XP) and atherosclerosis by the measurement of carotid intima media thickness (CIMT). In addition, the concurrent association between metabolic syndrome, dyslipidaemia and dyslipoproteinaemia was also assessed. ⋯ Alteration in apolipoprotein levels (A1 and B) in XP patients may predispose to cutaneous and systemic deposition of lipids, including atherosclerosis. Therefore, XP patients irrespective of their lesion size or serum lipid levels should be screened using CIMT for detection of subclinical atherosclerosis.
-
Meticillin-resistant Staphylococcus aureus (MRSA) hospital-acquired infection is associated with increased patient mortality. National guidelines state that shared patient equipment must be cleaned after use. The authors sought to identify MRSA contamination in a sample of non-disposable venepuncture tourniquets and audit cleaning habits between patient contacts. ⋯ Non-disposable venepuncture tourniquets are contaminated with MRSA and pose a risk to patients. The majority of clinical staff do not clean them between patient contacts as recommended by guidelines. The use of non-disposable venepuncture tourniquets should be abandoned. The introduction of disposable tourniquets to clinical practice should be an adjunct to current measures for MRSA prevention.