Clinical medicine (London, England)
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The Royal College of Physicians (RCP) recently published the National Early Warning Score 2 (NEWS2), aiming to improve safety for patients with hypercapnic respiratory failure by suggesting a separate oxygen saturation (SpO2) parameter scoring system for such patients. A previously published study of patients (n=2,361 admissions) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) demonstrated alternative scoring systems at admission did not outperform the original NEWS. Applying NEWS2 SpO2 parameters to this previously described cohort would have resulted in 44% (n=27/62) of patients who scored ≥7 points on the original NEWS and subsequently died being placed in a lower call-out threshold. NEWS2 loses the benefits of a unified, standardised scoring system and we suggest prospective research in this area before applying this adjustment.
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Chronic kidney disease (CKD) is common. A small proportion of patients with CKD progress to require interventions, which may include dialysis. Monitoring patients with CKD is supported by national guidelines. ⋯ We found that the VC was an effective monitoring system. None of the patients from the VC required emergency dialysis, suggesting robust surveillance. Survival was similar to patients with CKD discharged to primary care.
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The introduction of the term 'acute kidney injury' (AKI) along with an international classification scheme,1 caused some initial confusion, but most clinicians and many patients now understand that the term 'injury' denotes damage to the internal workings of the kidney, rather than physical trauma. However, of greater concern is the use of the term 'nephrotoxic' to include drugs that are, in most settings, nephroprotective. We argue that this imprecise terminology, unfortunately adopted by the National Institute for Health and Care Excellence (NICE) among others, is potentially harmful, and that the terms 'nephrotoxin' and 'nephrotoxic' should not be used to describe haemodynamically mediated and fully reversible effects of some drugs on excretory function.
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We present the case of a 41-year-old Australian woman with a 3-day history of fevers and migratory polyarthritis. Three weeks prior she had been treated by her GP with phenoxymethylpenicillin for acute tonsillitis. Examination confirmed synovitis. ⋯ The patient was treated for acute rheumatic fever with corticosteroids and a 10-day course of cephalexin. After 8 weeks, she made a full recovery and had normalised inflammatory markers and liver biochemistry. She was then commenced on monthly prophylactic intramuscular benzathine penicillin. This case study aims to raise awareness of the presentation, diagnosis and management of acute rheumatic fever.