Clinical medicine (London, England)
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Integrated care systems join up health and care services, so that people have the support they need, in the right place, at the right time. The aims include improving outcomes in healthcare, tackling inequalities in access and enhancing productivity and value for money. This is needed for neuroscience care as the traditional delivery of neuroscience care is inefficient, outdated and expensive, and can involve complex referral pathways and long waiting times. ⋯ This innovative collaboration has already significantly improved access, addressed inequalities due to borough variation and enhanced the delivery and quality of neuroscience care in our ICS. It is a translatable model that can be adapted to suit other regions in the UK. It fulfils many of the objectives of the integrated care system and these benefits are seen without the need for significantly more resource.
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Malaria remains a major global health problem. Transmission occurs in 84 countries across five continents, with almost 250 million cases and over 600,000 deaths each year. ⋯ With emerging resistance, climate change and the roll-out of the first malaria vaccines, the landscape of malaria is changing. Here we discuss the past, present and future of malaria.
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The World Health Organization (WHO) has stated that antimicrobial resistance is one of the greatest health threats facing humanity and is responsible for significant morbidity and mortality, with a disproportionate impact on vulnerable groups of patients. The WHO set out its global action plan in 2015 and most countries have their own national plans, which take a whole system One Health approach that includes infection prevention and optimising the use of antimicrobials through stewardship programmes and diagnostics. ⋯ AMS is effective and has proven benefits such as improved outcomes and reduced spread of resistance in hospitals. This paper highlights key principles for antimicrobial prescribing and highlights recent evidence, some of which has been practice changing.
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Staphylococcus aureus bacteraemia (SAB) is a multi-system disease associated with a 20-25% mortality in the UK setting. Many patients with SAB are admitted acutely unwell and are treated by the general physician. This review summarises the key management steps that a general physician needs to be aware of when treating patients with SAB. Successful management relies on appropriate empirical and definitive antimicrobial therapy, effective source control, accurate risk stratification and timely identification of metastatic foci of infection, as well as exclusion of infective endocarditis, which can be present in up to 10% of patients with SAB.
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What tests to send and when? This article examines the evidence for common microbiological tests and discusses their limitations and interpretation. Urine tests, surface swabs, blood cultures and screening swabs are all discussed in the context of a fictional clinical case.