Clinical medicine (London, England)
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Although chronic liver disease (CLD) constitutes a significant proportion of acute medical admissions, it is not known how CLD influences venous thromboembolism (VTE) prophylaxis decision making and low molecular weight heparin (LMWH) prescription. Furthermore, recent evidence suggests that VTE risk has been underestimated in CLD and that prophylactic LMWH is safe and may improve outcome in this patient group. We therefore evaluated VTE prophylaxis in patients with CLD and aimed to determine the factors contributing to decisions to prescribe LMWH. ⋯ Decision making appears to be affected by whether an admission is 'liver' or 'non-liver' related. Prophylactic LMWH was safe in this small cohort. Further studies are warranted to further inform LMWH prescription in CLD.
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Failure to provide prescribed medicines to inpatients has the potential to cause significant patient harm, to delay the resolution of the pathology and to increase the length of hospital stay. We measured the frequency at which medications were omitted in the non-admitting medical wards of a district general hospital, using two point-prevalence studies spaced one month apart. The results showed that the omission of prescribed medications remains a problem throughout the hospital stay of the patient. ⋯ The most common cause of omission was patients' refusal (47.22%), followed by patients' inability to take the medicine (22.7%). Medication unavailability came third (17.04%). Increased communication between medical, nursing and pharmacy staff, along with regular review of the patients by the patient team, with a view of reducing medication omission will go a long way in reducing the incidence of this problem.
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This study assessed the effect of endocrine input on the investigation of hyponatraemia and examined the prevalence of endocrine causes of hyponatraemia. This single-centre, retrospective study included 139 inpatients (median age, 74 years) with serum sodium (Na) levels ≤128 mmol/l during hospitalisation at a UK teaching hospital over a three-month period. In total, 61.9% of patients underwent assessment of volume status and 28.8% had paired serum and urine osmolality, and Na measured. ⋯ The prevalence of adrenal insufficiency was 0.7%, but basal serum cortisol levels were not measured in around two-thirds of patients. Despite 26.7% of patients having abnormal thyroid function tests, no patient was diagnosed with severe hypothyroidism. More widespread provision of expert input should be considered.
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Viral infections are the commonest cause of encephalitis, and the purpose of this article is to inform UK clinicians of the presentation, diagnosis and management of viral encephalitis in travellers returning to the UK. The classical presentation is as a triad of fever, headache and altered mental state. ⋯ This, coupled with the fact that untreated herpes simplex encephalitis (HSE) has a mortality of over 70%, means that aciclovir should always be included in the treatment of patients with suspected encephalitis, regardless of their history of travel. In the UK, the Rare and Imported Pathogens Laboratory (RIPL) at Public Health England can perform specific polymerase chain reaction (PCR) analyses on blood and CSF samples for many imported causes of viral encephalitis.
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Diarrhoea is probably the single most common medical complaint in returning travellers. The most common pathogens are entero-toxigenic Escherichia coli, Shigella, Salmonella and Campylobacter. ⋯ Blood in stools is a sign of invasive disease and should trigger exclusion of invasive amoebic disease. The use of empiric antibiotics may shorten illness but is complicated by the diversity of bacterial causes and emerging resistance.