Clinical medicine (London, England)
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The Royal College of Physicians (RCP) FallSafe care bundles are the recommended foundation for inpatient falls prevention in the UK. Yet there is a paucity of data to support its widespread use and the reductions in falls demonstrated in the original pilot and in subsequent small studies have not yet been reproduced in larger patient groups. Northumbria Healthcare NHS Foundation Trust (NHCFT) has seen a significant reduction in falls, falls per 1,000 bed days and harm from falls between 2013-2020 when combining the RCP FallSafe care bundles with a supportive observation policy (SOP) related to falls prevention. Highlighting the potential cost savings (∼£5.3 million over a 3-year period) has supported the growth and development of the NHCFT inpatient falls prevention service and the implementation of the SOP.
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Tobacco smoking is a major risk factor for a wide range of diseases, and smoking cessation significantly reduces these risks. Clinical guidelines for diseases associated with smoking should therefore include guidance on smoking cessation. This review updated evidence on the proportion of clinical guidelines that do so. ⋯ Over half (51%) made no mention of smoking, while 43% reported smoking as a risk factor for the development of the disease, 31% recommended smoking cessation and 19% provided detailed information on how to deliver smoking cessation support. These proportions were similar to those in our earlier review. Smoking cessation continues to be neglected in clinical management guidance for diseases caused by smoking.
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Case Reports
An unusual case of persisting hypoxia in a patient with a thrombolysed pulmonary embolism.
Exertional breathlessness and hypoxia are common presenting complaints in acute medicine. We describe a case where the patient continued to have persistent hypoxia even after the primary cause (pulmonary embolism) was diagnosed and treated. The hypoxia persisted as an enigma, its cause remaining elusive till diagnosed. Standard first-line investigations would not have reached the underlying diagnosis in this case and, as such, it demonstrates the keen clinical sense and complex investigative strategy required to solve the puzzle.
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There are literature reports of anabolic-androgenic steroid-induced rhabdomyolysis. Here we describe a case of a patient presenting with acute confusion and rhabdomyolysis, following an unwitnessed seizure. He had a background of alcohol excess. ⋯ The brief seizure was itself unlikely to have resulted in the severity of his rhabdomyolysis. Thus, we report a likely case of delayed rhabdomyolysis secondary to anabolic steroid use. The oropharyngeal dysphagia may be secondary to the rhabdomyolysis; there have been cases of this described in literature.
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Adult Paget's disease of bone is the second commonest metabolic bone condition after osteoporosis. The condition is characterised by increased bone cell activity, with bone-resorbing osteoclasts often larger and containing more nuclei than normal and osteoblasts producing increased amounts of disorganised bone. This leads to expanded bone of poor quality possessing both sclerotic and lytic areas. ⋯ The mainstay of treatment are the bisphosphonates, especially intravenous zoledronate which results in long-term suppression of bone turnover. ALP is the usual means of monitoring the condition, although more specific bone turnover markers can be helpful, especially in coincident liver disease. Patients should be followed up to monitor for biochemical relapse or development of complications, which may require medical or surgical intervention.