Clin Med
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Toxic shock syndrome (TSS) represents a fascinating example of immune activation caused by infection resulting in a dramatic and challenging clinical syndrome. TSS is commonly associated with tampon use and still causes significant morbidity and mortality in young healthy women. A misconception is that TSS presents with a skin rash and only occurs in women and children; however, it can occur in males and can present without skin changes. ⋯ Clindamycin is superior to penicillin in the treatment of this condition and significantly decreases the mortality rate in TSS. However, there is also an important role for intravenous immunoglobulins (IVIG). Early intensive care unit (ICU) as well as surgical team involvement (in selected cases) is required to avoid mortality which may approach 70%.
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The adequate supervision of trainee doctors seeing ward referrals is critical to the quality of patient care and medical training. This survey assessed the level and nature of supervision of trainees in neurology and comparable specialities. 123 neurology specialty registrars from nine deaneries across the UK and 81 dermatology, rheumatology and infectious disease specialty registrars from the London deanery completed the survey. ⋯ The remaining first year neurology and non-neurology registrars reported being primarily supervised by discussing cases with consultant (62% and 37% respectively) or being asked to contact a consultant if help was needed (35% and 42% respectively). The lack of adequate supervision of junior trainees seeing ward referrals has significant implications for both patient safety and training.
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Patients who remain unconscious and unaware after a brain insult challenge healthcare. Clinicians are faced with a clinical situation often outside their usual experience. ⋯ And people, especially family and friends, are faced with moral, legal and philosophical questions that have no easy answers. This conference launched national guidelines that should assist clinical teams and organisations, and should ensure that all patients and families receive a good quality service.
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This paper reports on a study that aimed to assess the inter-rater agreement of observable neurological signs in the upper and lower limbs (eg inspection, gait, cerebellar tests and coordination) and elicitable signs (eg tone, strength, reflexes and sensation). Thirty patients were examined by two neurology doctors, at least one of whom was a consultant. The doctors' findings were recorded on a standardised pro forma. ⋯ Almost perfect agreement was seen for cerebellar signs and inspection (a combination of speed of movement, muscle bulk, wasting and tremor); substantial agreement for strength, gait and coordination; moderate agreement for tone and reflexes; and only fair agreement for sensation. The inter-rater agreement is therefore better for observable neurological signs than for elicitable signs, which may be explained by the additional skill and cooperation required to elicit rather than just observe clinical signs. These findings have implications for clinical practice, particularly in telemedicine, and highlight the need for standardisation of the neurological examination.
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Obesity represents one of the biggest public health challenges facing us today. Urbanisation, sedentary lifestyles and the availability of inexpensive, highly palatable foods have promoted the increasing prevalence of obesity over the past 30 years. ⋯ We now understand that weight is regulated by neural mechanisms that regulate appetite and energy expenditure and that disruption of these pathways can result in severe obesity in some patients. These studies provide a framework for investigating patients and ultimately may guide the development of more rational, targeted therapies for genetically susceptible individuals with severe obesity.