Clin Med
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Non-alcoholic fatty liver disease (NAFLD) is increasingly common due to the rising prevalence of obesity in both children and adults. It is associated with metabolic risk factors such as diabetes mellitus, dyslipidaemia and hypertension, and is associated with increased mortality both from cardiovascular-related and liver-related deaths. Identification of those individuals with significant inflammation and fibrosis is a critical part of the patient pathway. Current treatments for NAFLD include weight loss from lifestyle modification or bariatric surgery, management of underlying metabolic risk factors and for those with end stage liver disease, liver transplantation.
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This paper describes a new tool called 'Day-of-Care Survey', developed to assess inpatient delays in acute hospitals. Using literature review, iterative testing and feedback from professional groups, a national multidisciplinary team developed the survey criteria and methodology. Review teams working in pairs visited wards and used case records and bedside charts to assess the patient's status against severity of illness and service intensity criteria. ⋯ The total number of patients not meeting criteria for acute care was 798/3,431 (23%, range 18-28%). Six factors accounted for 61% (490/798) of the reasons why patients not meeting acute care criteria remained in hospital. This survey gives important insights into the challenges of managing inpatient flow using system level information as a method to target interventions designed to address delay.
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Historical Article
FitzPatrick Lecture: King George III and the porphyria myth - causes, consequences and re-evaluation of his mental illness with computer diagnostics.
Recent studies have shown that the claim that King George III suffered from acute porphyria is seriously at fault. This article explores some of the causes of this misdiagnosis and the consequences of the misleading claims, also reporting on the nature of the king's recurrent mental illness according to computer diagnostics. In addition, techniques of cognitive archaeology are used to investigate the nature of the king's final decade of mental illness, which resulted in the appointment of the Prince of Wales as Prince Regent. The results of this analysis confirm that the king suffered from bipolar disorder type I, with a final decade of dementia, due, in part, to the neurotoxicity of his recurrent episodes of acute mania.
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IgG4-related disease is a recently recognised multi-system disease. Common organ involvement includes the pancreas, biliary tree and salivary glands. ⋯ In a single-centre cohort of 84 patients, we report cerebral involvement in three (4%) patients. Details of cerebral involvement in these patients are outlined, including pituitary involvement in two patients and a diffuse autoimmune-like encephalopathy in the other.