Clin Med
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Despite efforts, the detection of patients who are deteriorating in hospital is often later than it should be. Several technologies could provide the basis of a solution. Recording of vital signs could be improved by both automated transmission of the measured parameters to an electronic patient record and the use of unobtrusive wearable monitors that track the patient's physiology continuously. ⋯ Software algorithms could identify such patients with greater sensitivity and specificity than the existing, paper-based track-and-trigger systems. Electronic storage of vital signs also makes intelligent alerting and remote patient surveillance possible. However, the potential of these technologies depends strongly on implementation, with poor-quality deployment likely to worsen patient care.
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The past decade has seen the development of a network of specialist teenage and young adult cancer centres across the UK. These provide expertise in treatment across the spectrum of malignancies that occur in young adults, supported by multi-disciplinary teams that are able to provide the psycho-social support so necessary for this age group, and in a hospital environment that encourages social interaction while delivering expert medical care. The development of teenage and young adult (TYA) cancer as a specialty gained establishment backing in 2005, through NICE guidance which mandated that all 16- to 24-year-olds should be referred to specialist TYA cancer centres. The foundation of this achievement was set by a handful of committed individuals and the Teenage Cancer Trust, a charity that has acted as patient advocate and political pressure group, and that has brought to public attention the need for change while providing support for specialist staff and hospitals.
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Takotsubu cardiomyopathy (TC) describes transient left ventricular apical ballooning due to akinetic myocardium. It mimics acute coronary syndrome, with similar electrocardiogram changes and raised troponin, but visible coronary artery stenosis is missing. Patients usually recall a preceding stressful event and post-menopausal women are at greatest risk. ⋯ Treatment is supportive and complications include arrhythmias, cardiac rupture, thrombus formation and congestive cardiac failure. The prognosis is favourable and by definition cardiac function returns to pre-morbid levels. Mortality is rare (1–2%).
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Case Reports
Overfeeding and overhydration in elderly medical patients: lessons from the Liverpool Care Pathway.
This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. ⋯ Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.
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Syncope is a major healthcare problem with significant morbidity, mortality and healthcare cost. It is a common symptom with a complex pathophysiology and, therefore, several aetiologies. Tilt-table testing (TTT) is an important, yet perhaps not widely-used, test that forms part of the management of syncope. ⋯ TTT remains a common test modality and has great value when undertaken in the correct clinical context. This underlines the importance of a detailed clinical history. The European Society of Cardiology guidelines ensure a methodical and rational approach to syncopal patients and aide in choosing the right patient for the right test.