Clinical medicine (London, England)
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Rehabilitation following acquired brain injury improves health outcomes, reduces disability, and improves quality of life. We assessed the cost effectiveness of inpatient rehabilitation after brain injury in individuals with brain injury admitted to the Irish national tertiary specialist rehabilitation centre in 2011. Patients' score on the Disability Rating Scale (DRS) was recorded on admission and at discharge after intensive inpatient rehabilitation. ⋯ DRS scores, and therefore average levels of functioning, differed significantly at admission (2.3, between mildly and moderately dependent) and discharge (1.1, independent in special environments, p<0.01). Average weekly care costs fell from €629 to €242, with costs recouped within 30 months. Thus, substantial savings result from inpatient rehabilitation, and these savings could have been greater had we considered also the economic benefit of enabling patients to return to employment.
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Sexually acquired reactive arthritis (SARA) may present acutely to general physicians. It is important to consider the condition and to identify key features in the history and examination so that appropriate investigations are taken and optimum treatment is given. Involvement of relevant specialists in the management is essential and where sexually transmitted infections are identified, partner notification is required.
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In the UK, outcomes for people living with HIV are excellent. However, a quarter of those living with HIV do not know their status, and almost half are diagnosed late. Strategies to broaden HIV testing are needed. ⋯ The strategy removes the need for risk assessment, and is acceptable to patients and healthcare practitioners. If broadly implemented, it is likely to be effective at a public health level, and will help to reduce both undiagnosed HIV and late diagnoses of HIV. Here we review the emerging evidence base that supports the value of routine HIV testing in indicator conditions.
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Unscheduled hospital admissions from care homes are common and potentially avoidable but little guidance is available as to what constitutes an appropriate hospital admission. We surveyed healthcare professionals' opinions on a range of common scenarios affecting care-home residents. We developed seven clinical vignettes and an accompanying questionnaire. ⋯ Opinion on admission varied according to the case, with fewer than half of respondents agreeing for three of the seven cases. Recurring themes were uncertainty around services available to care homes and anticipatory care planning. The lack of consensus suggests that concepts surrounding inappropriate care-home admission are not shared by staff who provide care for this patient group.