Crit Care Resusc
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Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis causes autonomic disturbances, behavioural changes and abnormal movements. It is often a paraneoplastic phenomenon that occurs in association with ovarian teratomas and is the most common paraneoplastic encephalitis. ⋯ The remaining patients made substantial or complete neurological recoveries. This case series highlights that patients with anti-NMDA receptor encephalitis: • often require long periods of support in an intensive care unit; • may develop tracheostomy complications related to hypersalivation; • may develop life-threatening hyperthermia; • can have ovarian teratomas despite normal investigations; and • often have very abnormal movements that are difficult to control and make ongoing care difficult.
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Most studies of Rapid-Response Teams (RRTs) assess their effect on outcomes of all hospitalised patients. Little information exists on RRT activation patterns or why RRT calls are needed. Triage error may necessitate RRT review of ward patients shortly after hospital admission. RRT diurnal activation rates may reflect the likely frequency of caregiver visits. ⋯ About one-quarter of RRT calls occurred shortly after hospital admission, and were more common when caregivers were around. Early calls may partially reflect suboptimal triage, though the associated mortality appeared low. Late calls may reflect suboptimal end-of-life care planning, and the associated mortality was high. There is a need to further assess the epidemiology of RRT calls at different phases of the hospital stay.
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Comparative Study
Comparison of the diagnostic accuracy of measured and calculated free cortisol in acutely ill patients using the Coolens equation.
To investigate the agreement between two methods of measurement of plasma free cortisol in acutely ill patients; an indirect method using the Coolens equation, and direct measurement using high-performance liquid chromatography-tandem mass spectrometry, which is the gold standard. ⋯ The observed bias between the two methods is of a magnitude that would be expected to produce clinically relevant discrepancies. Due to the proportional nature of the error, adding a correction factor is not feasible. Results obtained from using the Coolens method to calculate free cortisol concentration in acutely ill patients should be interpreted with caution.