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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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.
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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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Nasogastric tube insertion is a common clinical procedure carried out by doctors and nurses in NHS hospitals daily. For the last 30 years, there have been reports in the medical literature of deaths and other harm resulting from misplaced nasogastric tubes, most commonly associated with feed entering the pulmonary system. In 2005 the National Patient Safety Agency in England assembled reports of 11 deaths and one incident of serious harm from wrong insertion of nasogastric tubes over a two-year period. ⋯ In the two and a half years following this alert the problem persisted with a further five deaths and six instances of serious harm due to nasogastric tube misplacement. This is a potentially preventable error but safety alerts advocating best practice do not appear to reliably reduce risk. Alternative solutions, such as standardising procedures, may be more effective.
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Typhoid fever should be considered in the diagnosis of any patient with a fever from the Asian community even in the absence of a travel history to an endemic region. Blood cultures taken prior to antibiotics are the best way of making the diagnosis early and preventing the complications that arise from a prolonged bacteraemia.