Volume 10, Issue 1, Pages 1 – 64 (2011)

An unusual cause of bilateral deep vein thrombosis in a young adult patient

Case Reports, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

We describe the case of a 17 year old male who presented with severe groin pain leading to inability to weight bear on his left leg. Investigation revealed extensive bilateral and proximal deep vein thrombosis, in association with an absent inferior vena cava and anomalous venous drainage system. We present a review of the literature surrounding this association, summarise the typical clinical presentation and common characteristics in this group of patients and discuss its management.

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An Unusual Cause of Septicaemia

Case Reports, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

Splenic infarction occurs when occlusion of splenic vasculature leads to ischemia, and subsequent tissue necrosis. It is a rare condition. Most patients have an underlying haematological or malignant process or a potential source of embolism. This article describes a patient who presented with unexplained sepsis to the acute medical unit; investigation revealed a splenic abscess and primary hyperparathyroidism, but no evidence of an underlying cause.

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Delivering outpatient antibiotic therapy (OPAT) in an Acute Medical Unit

Original Articles, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

Outpatient antibiotic therapy (OPAT) is being developed and practised in an increasing number of acute hospitals within the United Kingdom. This article is a review of the OPAT service delivered by a large inner city hospital over the last two years. The service demonstrates the key elements of OPAT demonstrating different delivery models, aspects of patient selection, spectrum of infections treated, choice and delivery of antimicrobials, efficacy, patient safety, outcomes, and the cost-effectiveness of this programme.

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What errors can be identified by Pharmacy led medicines reconciliation? A prospective study

Original Articles, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

Aim: To establish the nature and frequency of discrepancies identified by pharmacy staff during medicines reconciliation.(MR)

Methods: Pharmacy staff collected data prospectively from 161 patients over a 1 week period, including information on any prescription errors identified.

Results: In total, 62 patients (48%) taking one or more medications prior to admission to hospital had one or more discrepancies found by pharmacy staff during MR. The most common discrepancy was omission of one or more drugs.

Conclusions: Pharmacy staff identified several unintentional discrepancies in prescribing of medications at admission to hospital. Doctors should ensure that intentional changes to patient prescriptions are clearly documented.

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The impact of education on the knowledge and documentation of Driving and Vehicle Licensing Agency (DVLA) driving restrictions by doctors

Original Articles, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

The impact of education on the knowledge and documentation of Driving and Vehicle Licensing Agency (DVLA) driving restrictions by doctors.

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The workload of stroke thrombolysis: A prospective study in a district general hospital setting

Original Articles, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

Many hospitals are still setting up acute stroke thrombolysis services, often delayed by fears over workload. However, there are few data on how many patients require urgent assessment before one is treated.

We prospectively studied all referrals to the 24-hour stroke thrombolysis service, February 2009 - January 2010, in Southampton General Hospital.

128 patients were referred to the thrombolysis team and 20 received thrombolysis. The most common reasons for treatment exclusion were: stroke severity (37%), time from onset (26%) or CT findings (15%).

Approximately six patients required urgent assessment by the thrombolysis team for every one treated. These data are crucial to inform service planning.

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Budd-Chiari Syndrome – A review of the diagnosis and management

Clinical Reviews, Volume 10, Issue 1, Pages 1 - 64 (2011)

Abstract

Budd-Chiari syndrome (BCS) is the liver disease resulting from hepatic venous outflow obstruction comprising a triad of abdominal discomfort, hepatomegaly and ascites. Advances in the management of this disorder over the last three decades have dramatically improved survival.

We present a review of the management of BCS followed by a case which illustrates some key points in the diagnosis and treatment of this condition.

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The Rebirth of General, ‘Acute’ Medicine: will the baby survive?

Guest Editorial, Volume 10, Issue 1, Pages 1 - 64 (2011)

During the 1980s and 1990s general medicine was progressively displaced by medical specialties as the major focus of a consultant physician’s career. Fewer and fewer people were appointed as ‘general physicians with a specialist interest’, which had been the norm prior to this. Specialists whose main focus was their ‘ology’ were continuing to be expected to take their share of acute medical “takes”. Training for most medical specialties still encompassed training in General Internal Medicine (GIM). However, this often was truncated in favour of the main specialty and was even resented, by some, as interfering with their “proper” training. None of this was surprising: medical specialties were becoming more complex & many more treatments, interventions and diagnostic tools were becoming available. Simultaneously, working hours were decreasing, and training was taking place within a much more formalised structure.

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