Clinical medicine (London, England)
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People who inject drugs are disproportionately affected by acute/chronic bacterial and viral infections that are a cause of significant morbidity. Clinical presentations to the acute medical take vary from skin and soft tissue infections to complications of bacteraemias, and can be challenging with difficulties in adherence, pain management, early self-discharges and loss to follow-up. This review summarises the most recent UK epidemiology of injecting drug use and infection as well as clinical presentation and management.
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Acute stroke is the leading cause of disability in the UK and a leading cause of mortality worldwide. The majority of patients with ischaemic stroke present with minor deficits or transient ischaemic attack (TIA), and are often first seen by patient-facing clinicians. Urgent evaluation and treatment are important as many patients are at high risk of major vascular events and death within hours to days after the index event. ⋯ Each of these drugs has a unique mechanism and has been tested as a single agent or in combination. Aspirin, when given early is beneficial and short-term treatment with aspirin and clopidogrel has been shown to be more effective in high-risk TIA / minor stroke. This review concludes by highlighting gaps in evidence, including scope for future trials that could potentially change clinical practice.
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Sepsis-associated encephalopathy (SAE) describes acute cognitive dysfunction secondary to systemic or peripheral infection occurring outside of the central nervous system (CNS). Symptoms can range from mild confusion to coma and may precede the clinical signs of sepsis. Recognition that SAE is a potential differential diagnosis in patients presenting with delirium is important, as SAE is a diagnosis of exclusion. ⋯ Although mortality is often secondary to multiorgan failure rather than neurological sequelae, long-term cognitive and psychological morbidities have been reported in sepsis survivors. Early treatment (which can include prompt identification and source control of the infection) and good supportive care might improve cognitive outcomes. Future work should aim to improve understanding of both acute and chronic SAE with a focus on therapeutic interventions and improving patient outcomes.
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Cases of monkeypox, a double-stranded DNA virus that is closely related to smallpox, have recently increased in non-endemic countries, prompting fears of a new health emergency. Tens of thousands of cases have now been reported globally, with the majority of locations not having historically reported monkeypox. Here we review the epidemiology, transmission, diagnosis, management and prevention of monkeypox.
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Serious incident (SI) investigations aim to identify factors that caused or could have caused serious patient harm. This study aimed to use the Human Factors Analysis and Classification System (HFACS) to characterise the contributory factors identified in SI investigation reports. ⋯ Analysis of SI investigation reports using a modified HFACS framework allows important insights into what investigators view as contributory factors. We found an emphasis on human error but little engagement with why it occurs. Better investigations will require independence and professionalisation of investigators, human factors expertise, and a systems approach.