Clinical medicine (London, England)
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We aimed to describe and evaluate the National Early Warning Score (NEWS) in the 24 hours preceding an in-hospital cardiac arrest among general somatic ward patients. The 24 hours preceding the in-hospital cardiac arrest were divided into four timespans and analysed by a medical record review of 127:254 matched case-control patients. ⋯ The NEWS high-risk category was associated with an increase of 3.17 (95% confidence interval (CI) 1.66-6.04) to 4.43 (95% CI 2.56-7.67) in odds of in-hospital cardiac arrest compared to the low-risk category. NEWS, with its intuitive and for healthcare staff easy to interpret risk classification, is suitable for discriminating deteriorating patients with major deviating vital signs scoring high risk on NEWS.
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The Physician Specialty Recruitment Office of the Royal College of Physicians has overseen recruitment into core medical training since 2009. This has allowed trends in recruitment numbers and the experience of applicants to be followed. Current recruitment into core training is not providing a large enough pool of trainees to sustain adequate filling of higher medical specialty training posts and therefore ultimately bridge the consultant vacancy rates in the UK.
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Early warning scores (EWS) generated in a developed healthcare setting may not perform as well in low-resource settings in sub-Saharan Africa. ⋯ There were only marginal and no statistical differences in the performance of EWS generated in low- and high-resource healthcare settings in a cohort of unselected acutely ill medical patients admitted to a low-resource hospital in sub-Saharan Africa.
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Cardiovascular disease (CVD) remains one of the principal causes of morbidity and mortality in the world. International guidelines are being updated to take into account new evidence and improved health economics as drug patents expire. Recent studies have investigated the best lipid fractions to predict CVD, suggested additional CVD risk factors and a potential role for novel biomarkers while big data approaches have allowed improvements to be made to CVD risk calculators. ⋯ New data has been published on novel lipid-lowering therapies such as proprotein convertase subtilisin kexin 9 inhibitors but the role of these expensive drugs has yet to be fully settled and a diversity of approaches exists between guidelines. The role of lipid fractions outside LDL-C is unclear. There will be challenges in incorporating new non-linear data on omega-3 fatty acids that not only affect triglycerides but more directly CVD.
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Ion-exchange resins, sodium or calcium polystyrene sulfonate, are commonly used medications for management of hyperkalaemia. However, the drug can be associated with serious bowel injury. ⋯ Characteristic eosinophilic non-polarisable rhomboid shaped crystals were evident in the affected area of ulceration on histologic examination in addition to features of cytomegalovirus inclusions. We also hypothesised that gastroparesis secondary to autonomic dysfunction could have led to prolonged luminal contact time with polystyrene, further predisposing to bowel injury.