Clin Med
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ABSTRACT - The scale of pain intensity (SPIN)-screen is a simple visual tool for the screening and measurement of pain intensity, which is designed to be accessible by patients with cognitive and communication problems. It was applied prospectively in a consecutive cohort of 79 patients admitted to a tertiary specialist neurorehabilitation unit, of which 86% had significant cognitive/communicative disabilities. In all, 71 patients (90%) responded to the SPIN. ⋯ Repeat testing after 24 hours provided preliminary evidence for the stability and responsiveness of the SPIN-screen, but these require further evaluation. Of those who expressed a preference for one tool over the other, 70% preferred the SPIN. The study provides support for application of the SPIN-screen as a routine screening tool in this group of patients.
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Evidence shows clear benefit of anticoagulation for prosthetic heart valves but consideration must be given to coexisting medical conditions.
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In 2003, occasional military patients with hyponatraemia, hypokalaemia and alkalosis were encountered in Iraq. Development of central pontine myelinolysis in one patient indicated treatment should be cautious. Two years later, heat illness continued to occur during the very hot summer months and 23 cases were admitted to a British military field hospital near Basra, Iraq. ⋯ These electrolyte changes were compatible with secondary hyperaldosteronism but field conditions constrained further investigation. Hyponatraemia was probably due to salt deficiency rather than overhydration. In some military personnel summer salt supplementation could be essential during operations in hot countries.
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This questionnaire-based study assessed the attitudes of the general public to the symptoms of a transient ischaemic attack (TIA) and determined the current level of knowledge about the management of TIA among doctors. The public chose to wait for symptom recurrence before seeking medical advice for amaurosis (41%) and upper limb (UL) monoparesis (51%), sensory loss (68%), or paraesthesia (95%). However, medical advice would be sought most often for slurred speech alone (89%) or combined with UL monoparesis (99%). ⋯ In conclusion, the general public does not recognise the importance of TIA symptoms and the need for rapid assessment. This is compounded by deficiencies in the medical management of TIA. Stroke guidelines will remain ineffective without public awareness campaigns and physician education.
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Hubris syndrome is associated with power, more likely to manifest itself the longer the person exercises power and the greater the power they exercise. A syndrome not to be applied to anyone with existing mental illness or brain damage. ⋯ It is less likely to develop in people who retain a personal modesty, remain open to criticism, have a degree of cynicism or well developed sense of humour. Four heads of government in the last 100 years are singled out as having developed hubris syndrome: David Lloyd George, Margaret Thatcher, George W Bush and Tony Blair.