Clinical medicine (London, England)
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In November 2017, the deferral on blood donations from high-risk groups in Great Britain was changed to 3 months from last at-risk sexual contact following recommendations from the Advisory Committee on the Safety of Blood, Tissues and Organs. This represented a reduction from 12 months for men who have sex with men, and from a lifetime ban for sex workers. ⋯ Clearly it is vital that the welfare of blood transfusion recipients is prioritised and they are not exposed to unacceptable risks. However, with the increasingly sophisticated technology used to screen blood, it can be argued that the evidence shows that the reduction in deferral does not go far enough.
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Evidence-based audit tools were used to identify the antibiotic stewardship improvements necessary to meet the NHS England targets in a 750-bed teaching hospital. Antibiotic prescribing was reviewed against published evidence-based audit tools for 139 patients treated with antibiotics. Severe community-acquired pneumonia (CAP) median course length was 8.5 days. ⋯ Of these, 17% met the IV to oral switch criteria at 72 hours but were not switched. On average, antibiotic courses were 19% longer than recommended. Three key areas for improvement consist of: (a) implement the National Institute of Health and Care Excellence UTI Quality Standard - only 38% of patients treated for UTI met the UTI definition; (b) ensure antibiotic course lengths are in line with local prescribing guidelines - antibiotics were continued for 14% longer than recommended in local guidelines; (c) switch antibiotic therapy to oral when switch criteria met - 17% percent of patients initiated on IV antibiotics were eligible for oral switch by 72 hours and were not switched.
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Vitamin D is a fat-soluble vitamin essential for calcium homeostasis and bone health. Vitamin D toxicity or hypervitaminosis D is extremely rare. ⋯ This case, alongside other global case reports, highlights the potential dangers of unlicensed vitamin D replacement. We discuss the evidence for vitamin D replacement and remind readers of the current guidance on daily intake and supplementation.
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Case Reports
A case of Guillain-Barré syndrome (GBS) presenting with acute urinary retention and T6 sensory level.
Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating disease. Early recognition of this disease is crucial as it can progress to life-threatening conditions such as respiratory failure or autonomic dysfunction. ⋯ Sensory level and bladder dysfunction are more suggestive of acute myelopathy. We report a case of GBS presenting with acute urinary retention and T6 sensory level, which was successfully treated with plasma exchange.
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Although common, the long-term significance of -developing atrial fibrillation (AF) during a period of critical illness is unclear. We undertook a retrospective cohort analysis to -assess the rate of thromboembolism (TE) in patients -developing atrial fibrillation de novo during admission to our intensive care unit. ⋯ The unadjusted hazard ratio for TE in patients developing new AF compared with those not developing AF was 8.09 (95% CI 3.08-17.19, p<0.001). In patients admitted to critical care, the development of AF appears to be associated with a significantly increased risk of subsequent thromboembolism.