Clin Med
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Myocardial infarction (MI) and stroke are common acute conditions that regularly present as an emergency to hospital. Paradoxical embolism is a recognised complication of patent foramen ovale (PFO), and the literature shows that it can cause ischaemic stroke or, less frequently, acute MI. Ischaemic stroke and MI occurring simultaneously has a wide differential diagnosis, which should include a PFO, especially when occurring in young patients.
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Acute kidney injury (AKI) is associated with increased patient morbidity and mortality, and represents a significant financial burden for the NHS. The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD)'s report, Adding insult to injury, demonstrated that only 50% of patients who died from AKI received good care and 30% of patients had predictable and avoidable AKI. ⋯ The tips emphasise the importance of good basic medical care and the need for engagement with patients, healthcare professionals and hospital processes. The implementation of these tips in hospitals across the UK could potentially improve patient outcomes and reduce associated costs.
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Here we report on an audit performed to examine compliance with National Institute for Health and Clinical Excellence (NICE) guidelines for the use of anti-tumour necrosis factor alpha (anti-TNFalpha) in treating patients with ankylosing spondylitis (AS). Data from 17 rheumatology centres across the Midlands were collected prospectively from patients with AS attending outpatient clinics and retrospectively in patients receiving anti-TNFalpha but not attending outpatient clinics during the audit. In total, 80% of the 416 patients for whom data were collected were male. ⋯ After anti-TNFalpha treatment had started, regular 12-weekly assessments occurred in 46% of patients. Therefore, compliance with NICE guidance was found to vary among centres. Based on our audit, clinical capacity, and clinical or patient choice might be influencing the suboptimal adherence seen in assessment timing suggested by NICE guidelines relating to the use of anti-TNFalpha in treating patients with AS.
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Renal specialty medical training in the UK was reformed in August 2007, with an emphasis placed on competency-based training and the publication of a new curriculum and assessment blueprint. This model of training places additional time demands on both trainees and trainers, with implications for job planning and service delivery. We evaluated the resource requirements and impact on service delivery of implementing a high-quality training programme in renal medicine. ⋯ The mean total consultant time involved in implementing the training programme was 0.7 programmed activities (PAs) per trainee per week in the first year, which decreased to 0.5 PAs per trainee per week in the second year. This pilot study indicates that it is possible to integrate successful and high-quality specialty training in a busy clinical environment. The model outlined could form a template for postgraduate specialist training delivery in a variety of medical specialties.
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Case Reports
Ulcerative colitis presenting as pyrexia of unknown origin (PUO) without bowel symptoms.
Ulcerative colitis (UC) can rarely present with fever but it is unusual for it to be devoid of gastrointestinal symptoms. We report a case of UC that presented without bowel symptoms; fever being the only clinical feature. This case highlights the importance of considering UC as a cause of pyrexia of unknown origin (PUO) even in the absence of the lower gastrointestinal features commonly associated with this pathology. It is important to recognise this association as the incidence of UC is increasing in the older population.