Clin Med
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Staphylococcus aureus bacteraemia remains a significant cause of morbidity and mortality. National guidelines recommend that a minimum of 14 days of antibiotics should be used to treat uncomplicated bacteraemia. ⋯ This increase in compliance was noted in both methicillin-sensitive S. aureus (45% versus 58%) and methicillin-resistant S. aureus (42% versus 62%) bacteraemia. This audit demonstrated a simple and effective intervention that has improved the treatment of this potentially life-threatening condition.
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The range of treatments for rheumatoid arthritis (RA) has increased significantly in recent years, with a parallel improvement in patient outcome. The development and assessment of new therapies and therapeutic strategies relies on the availability of valid and reliable outcome measures to assess the diverse impact of RA on the patient's life. ⋯ Some measures have been combined into composite indices which are useful for summarising the patient's current condition and as primary outcome measures for clinical trials. There is still a need for better and more relevant tools especially for imaging multiple joints and for assessing fatigue.
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Polymyalgia rheumatica (PMR) is among the most common reasons for long-term steroid prescription with great heterogeneity in presentation, response to steroids and disease course. The British Society for Rheumatology and the British Health Professionals in Rheumatology have recently published guidelines on management of PMR. The purpose of this concise guidance is to draw attention to the full guidelines and provide a safe and specific diagnostic process with advice on management and monitoring--specifically targeted at general practitioners, general physicians and rheumatologists.
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There have been huge advances in endocrine care as a consequence of improved biochemistry and diagnostic techniques as well as improved imaging. Specialist transethmoidal endoscopic surgery has improved results in pituitary tumour patients and minimally invasive parathyroid surgery has had the same consequence in patients with parathyroid disease. Multidisciplinary teams have improved outcomes in a number of areas and, as described above, endocrinologists are dealing with more in the way of endocrine disease to expand boundaries. Much work remains to be done particularly concerning the care of children and adults with late endocrine effects of cancer treatment and obesity.
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Motor neurone disease (MND) is an adult-onset neurodegenerative disease which leads inexorably via weakness of limb, bulbar and respiratory muscles to death from respiratory failure three to five years later. Most MND is sporadic but approximately 10% is inherited. In exciting recent breakthroughs two new MND genes have been identified. ⋯ Malnutrition is a poor prognostic factor. In appropriate patients enteral feeding is recommended although its use has yet to be shown to improve survival. In ALS patients with respiratory failure and good or only moderately impaired bulbar function non-invasive positive pressure ventilation prolongs life and improves quality of life.