Clin Med
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Practice Guideline Guideline
Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen.
Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were first published by the British Committee for Standards in Haematology in 1996. Key aspects of these guidelines related to anti-infective prophylaxis, immunisation schedules and treatment of proven or suspected infection. A recent review of the guidelines was undertaken, with a view to updating the recommendations where necessary The guideline review process did not reveal any major change in patient groups considered at risk. ⋯ Recommendations for treatment of suspected or proven infection have not been significantly amended, but a local protocol should take into account relevant resistance patterns. There is an identified urgent need for further research into the effectiveness of varying vaccination strategies in the hyposplenic patient, and audit of infective episodes in this patient group should continue long term. Key guidelines are summarised below, together with grades of recommendation.
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In the UK, most patients admitted to hospital with acute neurological problems are not looked after or even seen by a consultant neurologist. As a result, the outcome of their care may be suboptimal. The Association of British Neurologists believes that, in order to provide a reasonable service, the number of consultant neurologists will have to increase more than threefold, to about 1,400. This should be achievable in the next 10-15 years and would bring UK neurological services up to the standards that already obtain in comparable European countries.
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A surgeon in Scotland has amputated the legs of two consenting, physically healthy patients. Although a handful of medical professionals believe that the desire for healthy limb amputation is symptomatic of a mental disorder that can be treated only by amputation, there is currently no consensus on what causes a person to desire such a disabling intervention. As long as there is no established body of medical opinion as to the diagnosis and treatment of such a condition, performing the surgery may be a criminal act. Given the ethically problematic history of surgery for psychiatric conditions, as well as the absence of sound medical data on this condition, surgeons should exercise great caution before complying with a request to amputate a healthy limb.