Clin Med
-
Comparative Study
Stability of plasma creatinine concentrations in acute complex long-stay admissions to a general medical service.
Assessment of glomerular filtration rate (GFR) is essential for calculating safe dosages of renally cleared drugs. Formulae for estimating reliable GFRs assume that plasma creatinine concentrations are stable. This study evaluates the variability of plasma creatinine (PCr) concentrations in patients admitted acutely to hospital. ⋯ A 10-year increase in age increased the odds of a rise in PCr over the next week by 11.1% (odds ratio = 1.11, 95% confidence interval = 1.03, 1.20; p = 0.007). Overall, baseline creatinine was a poor predictor of subsequent variation in PCr. GFR formulae for calculating renally-cleared drug dosages should be used with caution in elderly patients admitted acutely to hospital.
-
Patients admitted to UK hospitals with community-acquired pneumonia (CAP) require a chest radiograph for diagnostic purposes and to look for complications. This study investigated the association between a chest radiograph performed early in the process of care and clinical outcomes. ⋯ Antibiotics were administered after the radiograph in 89.8% of patients with a time to first radiograph < 4 hours compared with 40.7% of patients with time to first radiograph of > or = 4 hours (odds ratio 12.8, p < 0.001). A chest radiograph performed within four hours of hospital admission for CAP is significantly associated with a shorter hospital LOS and with antibiotic use after chest radiography.
-
We report a case of a 45-year-old man presenting with asomatognosia, or loss of body part ownership, when he experienced difficulty acknowledging that his arm was his own. His symptoms might easily have been considered to be of psychiatric origin. Instead they turned out to be due to highly focal stroke secondary to carotid dissection, an important and often missed cause of stroke in younger patients.