Hyponatraemia is the most common electrolyte disorder seen in clinical practice and the consequences can range from minor symptoms to life-threatening complications including seizures and cardiorespiratory distress. These effects occur as a result of fluid shifts due to deranged serum tonicity and subsequent cerebral oedema. The appropriate assessment and management of patients with hyponatraemia is not always achieved in clinical practice, which is partly related to challenges in teaching with limited clinical guidance. Recently, the European Society of Endocrinology, European Society of Intensive Care Medicine and European Renal AssociationEuropean Dialysis and Transplant Association produced clinical practice guidelines to focus on appropriate investigation and management of these patients. Within this manuscript, we highlight the key points from these guidelines, which are most pertinent to doctors of all specialties to improve the care of patients with this common electrolyte disorder.
BACKGROUND
Certification and registration of those who are sight impaired (SI) provides commissioners, and the providers of health and social care support to those with vision loss, with quantifiable data on the extent of blindness and sight impairment within a community. In this article, we outline the results of a comprehensive review of certification/registration pathways and processes in Northern Ireland and highlight achievements to date. The Developing Eyecare Partnership (DEP) CVI Task Group established by the Health and Social Care Board (HSCB) reviewed all certification/registration processes, pathways and issues that may have contributed to regional under certification/registration. This was undertaken to ensure timely certification/registration of those who may benefit from being certified as either Severely Sight Impaired (SSI) or SI, and in so doing improving patient pathways and access to services. Activity included a review of all available epidemiological data collected in the 2-year periods before and after the introduction of the new pathway (January 1, 2018). This work has resulted in changes to the terminology used in relevant Northern Ireland legislation and other documentation concerning certification/registration. It has also resulted in the creation of more timely and efficient referral pathways and improvements in the quality of information available on certification and the process. Increased awareness of the certification process by health and social care professionals has resulted in a 22.5% increase in certifications over the 2-year period, before COVID-19. Certification rates are now comparable with those from other areas of the United Kingdom. The workings of the DEP CVI group, over a 5-year period, have increased awareness about SI and SSI Certification among patients and Health and Social Care Providers and have improved the quality of local epidemiological data on vision impairment. A patient-based evaluation of the new pathway is planned for 2020.
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