Clin Med
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Practice Guideline
Assessment and management of alcohol dependence and withdrawal in the acute hospital: concise guidance.
Alcohol dependence is common among patients attending acute hospitals. It can be the major reason for attendance or a significant cofactor. Assessment of these patients in the acute setting can be challenging owing to the multidisciplinary approach required. ⋯ For this reason, assessment of dependence and prevention and management of acute alcohol withdrawal are often suboptimal. There is little existing guidance on how to manage this patient population, especially in non-specialist settings. With recently published National Institute for Health and Clinical Excellence (NICE) guidance on the management of dependence and withdrawal, now is the perfect time to produce concise guidelines in the hope that a more succinct suite of guidance can reach a larger audience.
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Therapeutic glucocorticoids are widely used to treat a variety of inflammatory conditions. However, the beneficial anti-inflammatory effects of glucocorticoids are limited by their detrimental effects on bone, including decreased bone density and increased fracture risk. Glucocorticoids adversely affect bone because they inhibit the amount of bone formed by osteoblasts. ⋯ Glucocorticoids are also generated by synovial tissue through the expression of 11beta-HSD1. Activity increases with joint inflammation and could represent a local anti-inflammatory system. The recognition that peripheral tissues generate glucocorticoids suggests that, for conditions associated with ageing or inflammation, one should consider glucocorticoid activity beyond the circulation.
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Enhanced education has been recommended to improve non-specialist management of acute kidney injury (AKI). However, the extent of any gaps in knowledge has yet to be defined fully. The aim of this study was to assess understanding of trainee doctors in the prevention, diagnosis and initial management of AKI. ⋯ Fifty percent of trainees could not define AKI, 30% could not name more than two risk factors for AKI and 37% could not name even one indication for renal referral. These serious gaps in knowledge highlight the need for enhanced education aimed at all training grades. Organisational changes may also be required to optimise patient safety.