Clinical medicine (London, England)
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The UK National Institute for Health and Care Excellence (NICE) updated its guidelines on stable chest pain in 2016 and recommended computed tomography coronary angiography (CTCA) as first line investigation for all patients with new onset symptoms. We implemented the guideline and audited downstream testing. ⋯ CTCA was an effective rule-out test for most patients. In patients that went on to have ICA, the overall yield of severe CAD was relatively high. This compares well with our previous audit applying the NICE 2010 guidelines which recommended ICA for all high probability patients wherein the yield of severe CAD was 30%.
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We aimed to describe and evaluate the National Early Warning Score (NEWS) in the 24 hours preceding an in-hospital cardiac arrest among general somatic ward patients. The 24 hours preceding the in-hospital cardiac arrest were divided into four timespans and analysed by a medical record review of 127:254 matched case-control patients. ⋯ The NEWS high-risk category was associated with an increase of 3.17 (95% confidence interval (CI) 1.66-6.04) to 4.43 (95% CI 2.56-7.67) in odds of in-hospital cardiac arrest compared to the low-risk category. NEWS, with its intuitive and for healthcare staff easy to interpret risk classification, is suitable for discriminating deteriorating patients with major deviating vital signs scoring high risk on NEWS.
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Diabetic patients with critical limb ischaemia may be affected by severe wound and skin ulcer infections. We report a case of a patient with bilateral femorotibial occlusion and methicillin-resistant Staphylococcus aureus infection. The patient was treated with femoroperoneal vascular bypass, debridement of wound dehiscence and targeted antimicrobial therapy for symptom resolution and healing of the wound.
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Supraventricular tachycardia (SVT) is a common cause of hospital admissions and can cause significant patient discomfort and distress. The most common SVTs include atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia and atrial tachycardia. In many cases, the underlying mechanism can be deduced from electrocardiography during tachycardia, comparing it with sinus rhythm, and assessing the onset and offset of tachycardia. ⋯ All patients treated for SVT should be referred for a heart rhythm specialist opinion. Long-term treatment is dependent on several factors including frequency of symptoms, risk stratification, and patient preference. Management can range from conservative, if symptoms are rare and the patient is low risk, to catheter ablation which is curative in the majority of patients.
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Observational Study
Integrating mental and physical health assessment in a neuro-otology clinic: feasibility, acceptability, associations and prevalence of common mental health disorders.
People with persistent physical symptoms are at risk of psychological symptoms, although recognition in medical settings is low. This is a retrospective observational study of 954 patients in a hospital outpatient neuro-otology clinic in order to assess the feasibility and acceptability of an electronic informatics system for collection of patient-reported outcomes, with real-time feedback to guide clinical care and describe the prevalence of anxiety and depressive symptoms. The proportion of patients successfully completing the screen was high (70%). ⋯ Suicidal ideation was present in 5%. Anxiety and depression were highly correlated to dizziness specific outcome measures (p<0.01). Electronic screening is feasible and acceptable to patients and staff in this setting, helping to identify service needs, inform care and monitor outcomes.