Clinical medicine (London, England)
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Frequent emergency readmissions may associate with health consequences. We examined the association between readmissions within 28 days of hospital discharge and mortality in 32,270 alive-discharge episodes (18-107 years). ⋯ Eight conditions associated with AR episodes had increased risk of mortality including congestive heart failure: HR = 2.7 (2.2-3.2), chronic pulmonary obstructive disease: HR = 3.0 (2.5-3.6), pneumonia: HR = 2.0 (1.8-2.3), sepsis: HR = 2.2 (1.9-2.5), endocrine disorders: HR = 1.9 (1.6-2.3), urinary tract infection: HR = 1.5 (1.3-1.7), psychiatric disorders: HR = 1.5 (1.1-2.1) and haematological disorders: HR = 1.5 (1.2-1.9). Frequent identical AR episodes, particularly from chronic and age-related conditions, are associated with increased mortality.
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Giant cell arteritis (GCA) is a systemic vasculitis with numerous potential complications and societal costs. After the publication of international guidelines, we found a number of deficiencies in the local care pathway of patients suspected to have GCA. These included poor referral and management pathways, and absence of dedicated monitoring and follow-up. ⋯ The introduction of diagnostic ultrasonography has meant that the need for biopsies has dropped by >80% reducing the annual cost of diagnostics by >£140,000. The introduction of a vasculitis specialist nurse has resulted in improving education, contact and speed of access to our service. The improvements in the service resulted in our service becoming a finalist in the Royal College of Physicians Excellence in Patient Care Award in 2020.
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Eating and drinking are essential for maintenance of nutrition and hydration, but are also important for pleasure and social interactions. The ability to eat and drink hinges on a complex and coordinated system, resulting in significant potential for things to go wrong. The Royal College of Physicians (RCP) has published updated guidance on how to support people who have eating and drinking difficulties, particularly towards the end of life. ⋯ The newly updated guidance aims to support healthcare professionals to work together with patients, their families and carers to make decisions around nutrition and hydration that are in the best interests of the patient. It covers the factors affecting our ability to eat and drink, strategies to support oral nutrition and hydration, techniques of clinically-assisted nutrition and hydration, and the legal and ethical framework to guide decisions about giving and withholding treatment, emphasising the two key concepts of capacity and best interests. This article aims to provide an executive summary of the guidance.
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One in five people in the UK are deaf, with hearing loss affecting more than 70% of people over the age of 70. Despite this being a higher prevalence than asthma, heart disease or diabetes, deaf people experience persistent health inequalities with poorer experiences and outcomes in disease prevention and management. Clear communication and patient engagement with health are key to better outcomes. ⋯ Foundation doctors have regular and prolonged contact with their patients, and often feel underprepared when interacting with patients with hearing loss. This article aims to highlight these communication barriers and suggest changes for improvement. Improvement will require adaptations from both individual and organisational perspectives, with patient care as a clear focus for change.
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Insulin is required for all people living with type 1 diabetes, and may be required in nearly half of those with type 2 diabetes. It is a complex drug, manufactured in several forms and utilised in various regimens and devices. There is evidence that non-specialist professionals lack confidence in insulin therapy and, in addition, insulin-related prescribing errors are common in hospital care. In this article, I summarise commonly used insulin regimens, along with indications and safety considerations when prescribing insulin therapy.