Clin Med
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Epilepsy is the most common serious chronic neurological disorder affecting between 0.5% and 1% of Western populations. Most patients take anti-epileptic drugs (AEDs) for years if not decades, and are commonly admitted to hospital with seizures. Many have symptomatic epilepsy, arising as a consequence of another disorder, for example a brain tumour. ⋯ This can be difficult when neurology services are not on-site or easily available. This article gives a practical overview of difficulties relating to AEDs and their management, with the focus on problems commonly encountered by non-neurologists. These include the patient who is acutely unwell, pregnant or elderly; AED side effects and drug interactions; status epilepticus and AED blood levels.
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Severe acute respiratory syndrome (SARS) is a novel coronavirus infection which broke out in Hong Kong in March 2003. Princess Margaret Hospital was designated to manage this new, mysterious and serious disease. Healthcare workers had to work under extremely stressful and often risky conditions to care for patients. ⋯ Patients suffered even more, not only due to physical discomfort, but also because of the fear of isolation and death away from family and friends. Health authorities learnt their lessons in the outbreak and formulated emergency plans for future infectious disease epidemics. The healthcare infrastructure has been examined and upgraded with regard to intensive care capacity, infection control measures, professional training, manpower deployment, staff facilities, and stockpiling of drugs and personal protective equipment.
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Most patients with primary hyperparathyroidism (PHPT) are asymptomatic at presentation. This presents the dilemma whether to treat surgically or manage by conservative follow-up. ⋯ Others, such as effects on cardiovascular function or the risk of malignancy are more controversial. These factors are critical to decisions relating to surgical or conservative management of mild PHPT.
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In a paper in the last issue of Clinical Medicine, some of the background to attitudes to newly dead bodies, the current context of an urgent need for organs for transplant and the objections to calling a proposal to address this 'presumed consent' were outlined. Here further concerns are explored.
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Academic health centres (AHCs) bring significant economic and health benefits to a community. This study focuses on four integrated AHCs in the USA. They are described as the 'traditional great' or 'transformational great', where a number of common characteristics have been identified on how these organisations have demonstrated superior performance over time. The conceptual framework of 'good to great' provides a structure to explore key factors that support enhanced performance.