Clinical medicine (London, England)
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Rickettsial illnesses, comprising mainly spotted fever group, typhus group and scrub typhus, are vector-borne re-emerging or newly emerging febrile illnesses where humans are an accidental dead-end host. They are a major cause of non-malarial febrile illnesses among returned travellers. ⋯ Almost all rickettsial infections respond to anti-rickettsial antibiotics such as doxycycline within 48-72 hours. Awareness of rickettsial illnesses and their various clinical presentations helps in early diagnosis and institution of appropriate treatment and hence prevent morbidity and mortality.
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Clinicians are responsible for both commencing and stopping medications. This study evaluates the attitudes of older acute medical inpatients about deprescribing. ⋯ Conversely, they also reported greater concerns about stopping medications. We discuss these findings in the context of the positive and negative effects of deprescribing, in the context of patient engagement and shared decision making, and how clinicians can work with inpatients to reduce potentially inappropriate medications.
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Melioidosis is an infectious disease with high mortality and a wide spectrum of clinical manifestations. Successful treatment requires lengthy antibiotic regimens, making microbiological diagnosis crucial. In this article, we briefly review the diagnosis and management of melioidosis from the clinician's viewpoint.
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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a growing public health epidemic. In the UK, over 1.3 million people have a diagnosis of AF and an estimated 400,000 remain undiagnosed. AF-related strokes account for a quarter of all strokes and, as AF episodes are often asymptomatic, are still often the first manifestation of AF. ⋯ Diagnostic accuracy of single-lead electrocardiography (ECG) generated by the latest iteration of wearable devices is excellent and, in many cases, superior to general practitioner interpretation of the 12-lead ECG. High-quality ECG from wearable devices that unequivocally shows AF can expedite AF detection. Otherwise, there is a real risk of delaying AF diagnosis with the potential of devastating consequences for patients and their families.