Clin Med
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Diabetes mellitus is an emerging problem in the developing world. In sub-Saharan Africa, for example, the incidence and prevalence of the disease is unknown, diagnosis is often made on the basis of poor information and a loosely defined set of criteria, and access to oral hypoglycaemic agents and insulin is patchy and expensive. The best system of management is currently unclear and this article explores lessons learnt, good practice and the applicability of the structured 'directly observed treatment, short course' (DOTS) approach (the current best care system for tuberculosis disease management in resource-poor settings) to the management of chronic diseases such as diabetes.
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Up to 4% of inpatients are in hospital solely to receive intravenous antimicrobial therapy. Outpatient parenteral antimicrobial therapy (OPAT) offers the opportunity for improved efficiency and patient choice through early discharge from hospital or admission avoidance, while maintaining quality of care. OPAT aligns well with key priorities in the new NHS and in this article I explore how new developments in the national healthcare context might be exploited to promote the ongoing evolution of OPAT in the UK.
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The misdiagnosis of MND (particularly of the ALS phenotype), is uncommon. Atypical presentations, particularly of focal onset and with pure LMN or UMN signs, present a more difficult diagnostic challenge, although perhaps reassuringly, treatable mimics are rare. A working knowledge of potential alternative conditions and MND diagnostic pitfalls should help to reduce the misdiagnosis rate, particularly if the key points are considered.