Clinical medicine (London, England)
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Review Historical Article
100 years of the Royal Air Force's contribution to medicine: providing care in the air and delivering care by air.
The Royal Air Force (RAF) came into being during World War I as the world's first independent air force on the 1 April 1918, amalgamating elements of the Royal Flying Corps (RFC), itself established in 1912 and the Royal Naval Air Service which had formally separated from the Admiralty's administered Air Wing of the RFC in 1915. The RAF therefore celebrates its 100th anniversary in the same year that the Royal College of Physicians of London celebrates its 500th. This article will cover the contribution that military aviation has made to medicine since 1913 with the emphasis of three examples focusing on delivering care by air, providing care in the air and in developing systems for supporting aircrew or patients at the extremes of physiological stress.
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Safe exclusion of pulmonary embolism (PE) is a common problem in acute medicine. Common care pathways usually involve the use of a pre-test probability score with a D-dimer test to aid clinical decision-making. Unfortunately, the specificity of many D-dimer assays decreases with age. ⋯ D-dimers in patients with low or moderate Wells score were analysed for both conventional and age-adjusted cut-offs. The use of an adjusted D-dimer showed a sensitivity of 0.97 (95% CI 0.9-1.0) while the specificity increased from 0.07 (95% CI 0.04-0.11) for the conventional cut-off to 0.32 (95% CI 0.27-0.38) for the age-adjusted cut-off. Using a 5 x patient's age-adjusted D-dimer cut-off is both safe and showed an increased specificity comparable to those published previously on other D-dimer assays.
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Public Health England (PHE) issued a guidance report on the management of Mycobacterium chimaera endocarditis following cardiac valve surgery. M chimaera is a non-tuberculous mycobacteria (NTM) belonging to mycobacterium avium complex (MAC). ⋯ Prosthetic valve endocarditis (PVE) presents as the frequent and severe form of infective endocarditis (IE). The objective of this review is to discuss the role of clinicians in assessment, treatment and reassurance of all the patients who are recalled for clinical consultation following their risk of suspected M chimaera infection after open-heart surgery.
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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.