Venous thromboembolism (VTE) is a significant cause of mortality and morbidity among hospitalised patients. A VTE risk assessment reduces this through facilitating correct prophylaxis. Since 2010, the Commissioning for Quality and Innovation payments framework dictates that >95% adult inpatients must have a VTE risk assessment within 24 hours of admission. This target is not currently being met by the urology department at Guy’s and St. Thomas’ Trust (GSTT). Following analysis, a quality improvement project aimed to increase VTE risk assessment rates for patients admitted under urology at GSTT. Two series of interventions were introduced following the Plan, Do, Study, Act structure aimed at urology theatres and wards, respectively. These boosted awareness of the VTE risk assessment and streamlined it into routine surgical workload. Despite not reaching the 95% target, the project increased rates among patients admitted directly to surgical units by 5%–8%. It highlighted the difficulties in driving a change in established routine and demonstrated a need for firmer interventions with effective communication.
Purpose of reviewFever is common within rheumatology but it is often challenging to identify its source. To do so correctly is paramount in patients with an underlying inflammatory condition receiving immunosuppressive therapy. This review article looks at the available evidence and merits of both 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans and new proposed biomarkers in determining the cause of fever within rheumatology.Recent findings18F-FDG PET/CT scans are already an established tool in the detection and diagnosis of malignancy and are emerging for use in fever of unknown origin. More recently, they have been used to identify rheumatological causes of fever such as large vessel vasculitis and adult-onset Still’s disease. Within these conditions, biomarkers such as procalcitonin and presepsin may help to differentiate endogenous from exogenous pyrogens.Summary18F-FDG PET/CT scanning shows promise in locating the source of pyrogens and may be superior to other conventional forms of imaging. As evidence and test availability increases, its use is likely to become commonplace in the diagnostic work-up of fever. Once a source is located, selected biomarkers may be used to confirm a cause.
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