Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical-and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.
Summary
Rifampicin occasionally causes thrombocytopenia when given as part of an intermittent regimen. A case is reported of severe thrombocytopenia developing after one dose of rifampicin, following a 4-month gap in daily therapy. The literature on rifampicin-induced thrombocytopenia is reviewed.
This article discusses the effect of the role of the modern matron on healthcare-associated infection (HCAI) and hospital cleanliness. The way the modern matron's role is developing is examined in relation to HCAI in a large acute NHS trust. As set out in Implementing the NHS Plan: Modern Matrons (Department of Health (DH) 2001), the role of modern matron includes a responsibility to lead clinical teams in the prevention of HCAI.
The commissioning of health services for all prisoners in publicly run prisons in England was transferred to local Primary Care Trusts in April 2006, pledging to provide an equivalent standard of health care as that in the community. We reviewed our experience of providing a specialist in-reach HIV service by performing a retrospective case notes review of all HIV-positive prisoners who accessed care from the prison genitourinary medicine service in three London prisons. A total of 112 HIV-positive prisoners were seen by the prison health-care service between April 2004 and 2006. This is the first study to look at how well HIV services are being provided during this transitional period of commissioning health services and provides insight into the challenges facing prison health-care providers. Good HIV outcomes are possible in prison but frequent transfers within the prison system and lack of effective HIV training among prison staff represent barriers to good care.
This article discusses the effect of the role of the modern matron on healthcare-associated infection (HCAI) and hospital cleanliness. The way the modern matron's role is developing is examined in relation to HCAI in a large acute NHS trust. As set out in Implementing the NHS Plan: Modern Matrons (Department of Health (DH) 2001), the role of modern matron includes a responsibility to lead clinical teams in the prevention of HCAI.
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