The impact of consultant-delivered multidisciplinary inpatient medical care on patient outcomes

Consultant-delivered care has been shown to improve outcomes for acute medical patients. However, the ideal composition of a medical team to support consultant-delivered care is not clear and little is known about the effect of continuing consultant-delivered care until the patient is discharged. Between December 2011 and April 2012, 260 general medical patients requiring inpatient care were managed by a consultant-delivered multidisciplinary team (CD-MDT) and 150 patients by a standard consultant-led team of trainee doctors. The length of hospital stay was significantly lower for patients managed by a CD-MDT than for those managed by a standard team (4-5 days vs 7 days, p<0.001). No difference between the groups was seen for readmission rates, patient safety or mortality. In conclusion, a CD-MDT is a safe and effective model of inpatient medical care and is associated with a shorter length of hospital stay.

Typical bronchial carcinoid tumour presenting as pneumomediastinum

The authors present a case of a 44-year-old man who presented with acute onset shortness of breath. He had severe subcutaneous emphysema and his chest x-ray and CT scan confirmed presence of air in mediastinum. Rigid bronchoscopy revealed a bronchial tumour which was proven to be a carcinoid on histology. Patient recovered following the surgical excision of the tumour.

Draft risk assessment of the public health impact of Escherichia coli O157:H7 in ground beef

An assessment of the risk of illness associated with Escherichia coli O157:H7 in ground beef was drafted in 2001. The exposure assessment considers farm, slaughter, and preparation factors that influence the likelihood of humans consuming ground beef servings containing E. coli O157:H7 and the number of cells in a contaminated serving. Apparent seasonal differences in prevalence of cattle infected with E. coli O157:H7 corresponded to seasonal differences in human exposure. The model predicts that on average 0.018% of servings consumed during June through September and 0.007% of servings consumed during the remainder of the year are contaminated with one or more E. coli O157:H7 cells. This exposure risk is combined with the probability of illness given exposure (i.e., dose response) to estimate a U.S. population risk of illness of nearly one illness in each 1 million (9.6 x 10(-7)) servings of ground beef consumed. Uncertainty about this risk ranges from about 0.33 illness in every 1 million ground beef servings at the 5th percentile to about two illnesses in every 1 million ground beef servings at the 95th percentile.

Bilateral subcapital neck of femur fractures after eclamptic seizures

A previously healthy female sustained bilateral subcapital femur fractures during an eclamptic seizure. This complication has not been previously described in association with eclampsia. Clinicians need to be aware of this potential complication and investigate postseizure hip pain appropriately.

Extracorporeal membrane oxygenation in the management of severe thoracic trauma: a case report

We describe a case where extracorporeal membrane oxygenation was used for seven days to facilitate surgery and respiratory therapy in a multi-trauma patient with severe pulmonary contusions, bilateral bronchopleural fistulae with recurrent pneumothoraces. The patient made a good recovery and was discharged from hospital after three months.