Clinical medicine (London, England)
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'Sensible on Strength' (SoS), a local public health initiative, is aimed at reducing high-strength beer and cider availability. The objective of this study was to assess its impact on local hospital admissions with alcohol-related liver disease (ALD) and on drinking behaviour. ⋯ Despite having no apparent impact on the clinical spectrum of local ALD admissions, it is conceivable that longer follow-up is needed to determine the true impact of this initiative.
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McKittrick-Wheelock syndrome (MWS) is a rare cause of acute kidney injury and electrolyte depletion. It is driven by a secretory tumour or polyp of the distal large colon. Although rare, it is a diagnosis that must be considered in patients presenting with the above conditions. ⋯ The diagnosis of MWS was established and treatment options discussed. Surgical intervention was declined, and management consisted of patient education, the careful replacement of fluid and electrolytes and close monitoring of electrolytes and kidney function. After a short period as an inpatient, the patient went on to be discharged and, with regular follow-up, has managed to continue a normal life.
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Driving improvements in patient safety has been a core goal of the Academic Health Science Networks (AHSNs) in England since their inception in 2013. The National Patient Safety Collaborative Programme, nested within the 15 geographically located AHSNs, was established in 2014 in response to the Berwick review. ⋯ Case studies illustrate the AHSNs' contribution to support national ambitions, including the adoption of the National Early Warning Score (NEWS) 2, and the impact of regionally-led work on patient outcomes, such as reducing mortality from sepsis and acute kidney injury. We set out current activities, opportunities for physician engagement and plans for future work.
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Case Reports
Piriformis syndrome as the only initial manifestation of septic sacroiliac osteomyelitis.
Piriformis syndrome refers to sciatica symptoms that do not originate from spinal root compression, but involve the overlying piriformis muscle. Diagnosis is clinical since there are no definitive tests to confirm the diagnosis. Piriformis syndrome is often misinterpreted as sciatica or other pains. ⋯ Thus, prompt diagnosis is crucial to the prognosis. Here, we report a patient suffering from acute pelvic osteomyelitis with piriformis syndrome as the only initial manifestation without fever. This unusual manifestation rendered prompt and correct diagnosis difficult.