Clinical medicine (London, England)
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The prevalence of smoking remains stubbornly high in the UK despite comprehensive tobacco control measures. A national quality improvement (QI) approach to enhance the treatment of an estimated 1,000,000 annual hospital admissions of tobacco smokers could provide a new opportunity to improve population health and reduce healthcare demand. Barriers to QI include knowledge, costs and competing demands. This study aimed to evaluate the feasibility and effectiveness of a national QI programme hosted by the British Thoracic Society, focused on improving NHS tobacco dependency treatment in acute hospitals. ⋯ This novel, national, online QI programme supported participating multidisciplinary teams in acute trusts across the UK to deliver tobacco dependency treatment pathway improvements using QI tools and methodology. This programme demonstrated the feasibility and effectiveness of delivering a national QI programme, at low cost using a microsystems approach applied to an important area of clinical medicine.
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If a woman is acutely confused in pregnancy, she will most likely present to an unscheduled care setting outside of maternity services. It is therefore essential that all clinicians working within general medicine are comfortable assessing pregnant women in this context. ⋯ Certain life-threatening diagnoses have been further discussed in more detail (Wernicke's encephalopathy, hyponatraemia, hypercalcaemia, acute fatty liver of pregnancy and thrombotic thrombocytopenia purpura). These conditions have been chosen as there is a significant risk of maternal mortality and morbidity as well as poor fetal outcomes if not recognised and treated early.
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Adequate control of thyroid function is crucial for optimal pregnancy outcomes and neurodevelopment of the offspring, and testing for thyroid function is ideally performed using manufacturer- and gestation-specific reference ranges. While universal screening for thyroid dysfunction is not recommended, targeted case finding of women at risk of thyroid disease during pregnancy is advised. ⋯ A significant body of evidence has accumulated in recent years, including large systematic reviews and meta-analyses of observational studies determining effects of thyroid dysfunction on pregnancy and fetal outcomes. In addition, outcomes from important randomised trials continue to inform current guidance on how to best care for women with thyroid dysfunction before and during pregnancy.
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The value of the neutrophil-to-lymphocyte ratio (NLR) in predicting outcomes in patients hospitalised with community-acquired pneumonia (CAP) remains debated. This study evaluated whether NLR independently predicts clinical outcomes and enhances the predictive performance of the CURB-65 score in patients with CAP. ⋯ NLR independently predicts adverse outcomes in patients hospitalised with CAP but does not improve the predictive performance of the CURB-65 score.