Brit J Hosp Med
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Hypercalcaemia is a common metabolic abnormality and its differential diagnosis is vast. Immobility is an uncommon cause of hypercalcaemia. Immobilisation hypercalcaemia is independent of parathyroid hormone and is associated with low levels of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D. ⋯ Although immobilisation hypercalcaemia is a diagnosis of exclusion, physicians need to be aware of this condition to avoid excessive and invasive investigations when all other causes of parathyroid hormone-independent hypercalcaemia have been excluded. Management of immobilisation hypercalcaemia revolves around early mobilisation and rehabilitation together with pharmacotherapeutic agents such as intravenous isotonic saline, calcitonin and bisphosphonates. Denosumab may be a potential alternative yet off-label treatment for immobility hypercalcaemia in patients with renal insufficiency.
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Review
Ethical considerations during a pioneering surgical procedure: porcine cardiac xenotransplantation.
Preclinical advances in life-sustaining porcine cardiac xenotransplantation from donor pigs to baboons have paved the way for the performance of porcine cardiac xenotransplantation in a human. This procedure was performed with emergency use authorisation granted by the United States Food and Drug Administration under the umbrella of investigational new drug use on compassionate grounds. The patient was denied candidacy for durable mechanical circulatory support and heart transplantation as a result of non-adherence to medical advice. ⋯ This article focuses on some of the ethical conflicts encountered in relation to the use of mechanical circulatory support, pretransplant evaluation, shared decision making during informed consent, infectious disease risk, preclinical and clinical testing, and the role of regulatory bodies during performance of the first human porcine cardiac xenotransplantation. An increase in human trials of xenotransplantation procedures is imminent. Potential ethical conflicts associated with xenotransplantation should be addressed appropriately.
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Microbiologists are frequently consulted for guidance on the investigation and management of infection, including antimicrobial prescribing in hospital settings. There is a rising demand for timely microbiology advice in the context of increasing global travel and antibiotic resistance, which give rise to complex cases. However, junior doctors are seldom trained in making effective referrals. ⋯ This benefits patients who are more likely to receive appropriate treatment. This article presents guidance, developed in consultation with specialists, to improve the quality of referrals to microbiologists. This includes the information required for a high-quality referral, and signposts referring clinicians to existing resources which are suitable for simpler cases not requiring specialist input.
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Organising pneumonia was first described in the context of respiratory infection, but over time has become established as its own entity. It is an area of diagnostic complexity because of the non-specific presenting symptoms and signs that can often mimic other respiratory pathology. Multidisciplinary review to correlate clinical, radiological and histopathological features can aid timely and effective diagnosis. This article discusses the epidemiology, aetiology, clinical, radiological and histopathological features, investigation and management of organising pneumonia.
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The COVID-19 pandemic challenged the NHS to make rapid adjustments to practice to ensure that patients could continue to access vital treatments while reducing the risk of infection. A roundtable discussion was convened, including professionals from cancer care delivery and those working in patient involvement, to discuss experiences during the pandemic and to offer recommendations for the safe transition and implementation of cancer care in the community setting.