The Practitioner
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After acute severe brain damage, many people are rendered unconscious or comatose for more than 24 hours. Although a significant number can still recover fully, some will not and a substantial minority remain unconscious for days, weeks or longer. These patients have a prolonged disorder of consciousness. ⋯ The family must be closely and fully involved from the outset. Families legally cannot, and should not be asked to, make decisions concerning healthcare, unless a family member is a legally appointed deputy or has been given power of attorney in relation to healthcare matters. Family members can, and should be asked to, give information about the patient's wishes, life choices etc as part of the best interests decision-making process, and they should be involved in best interests meetings.
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About 20% of all adult emergency admissions are affected by acute kidney injury (AKI) and the mortality rate is almost 25%. It has been estimated that AKI, excluding cases in the community, causes more than 10,000 preventable deaths a year in England. AKI represents a wide spectrum of injury to the kidneys, not just kidney failure, the vast majority of AKI cases start with an illness in the community. ⋯ The definition of AKI now includes any adult with > or = 26 micromol/L rise in creatinine from baseline over 48 hours or less, or > or = 50% rise in creatinine from baseline known or presumed to have occurred over seven days or less. In patients with known or suspected AKI all nephrotoxic drugs should be suspended. The use of NSAIDs should be avoided, ACE inhibitors and angiotensin receptor blockers should be suspended during any episode of vomiting and/or diarrhoea.
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Alopecia areata is a chronic inflammatory non-scarring condition affecting the hair follicle that leads to hair loss ranging from small well defined patches to complete loss of all body hair. In about 80% of affected individuals there is spontaneous regrowth within a year. It can present at any age, although 60% of patients develop their first episode of hair loss before the age of 20. ⋯ Close examination of the periphery of a lesion with a magnifying glass will often reveal short hairs which taper in diameter from their tip to the point at which they emerge from the skin. These 'exclamation mark' hairs are diagnostic of alopecia areata. Individuals with alopecia areata should be referred for dermatological advice if there is diagnostic uncertainty, they have extensive hair loss, they are suffering severe psychological distress or they would like a wig.