Hospital management of community-acquired pneumonia in Malta

Community-acquired pneumonia (CAP) remains a common diagnosis requiring hospital admission and a leading cause of death worldwide. No local guideline is currently available for the management of CAP. Our aim was to evaluate current practices in the management of CAP at Mater Dei Hospital, Malta. In this prospective study we looked at all adult patients admitted with CAP in winter and summer (105 consecutive days for both seasons). Data collected and analysed included: basic patient demographics; symptoms at presentation; antibiotics prescribed and time of administration; co-morbidities; CURB65; blood oxygenation levels; admission plan; length of stay and follow-up; length of stay, follow-up chest radiography and death within 30 days from hospital admission. Of note the average time to first dose antibiotic was 7 hours 48 minutes (range 2 hours 13 minutes – 14 hours 17 minutes). A total of 178 patients (50.1%) were admitted with CURB65 scores of 0 (n=99) and 1 (n=86). Most of these could have been discharged and managed in the community with significant impact on hospital bed occupancy. Eventual standardisation of acute management of CAP by the set-up of a local guideline will improve outcome and reduce hospital bed occupancy.peer-reviewe

The time of criticalthinkings

An island: there, in smaller times in a timeless sea. Stung by recent events, its people achieve consensus on the need for critical thinking. Improbable. But impossible things had happened, even there. They surprise themselves, but something had to be done. ‘As a nation, we must think more, and we must think more deeply,’ they declare through those who think up this kind of thing. ‘Our thinking must not only go deeper, it has to develop the capacity for critique,’ the people sort of learn to say. Or, as the intoning tells them, you, we, might not survive ourselves. Having got this far, they turn their half a million backs on the political groupings that had previously dulled that capacity with the rewards of loyalty, as well as on the religions that had schooled them in the rewards of faith. They are thrilled by this double emancipation. Some time is needed before the thrill can be worked off. Pragmatism, the greatest of survivors, then asserts itself. So not unreasonably they ask, ‘But who will teach us critical thinking?’peer-reviewe

‘One day I will find the right words, and they will be simple’— Rethinking DNACPR at a national level

Evidence has shown a diversity of practices and terminology concerning the implementation and documentation of Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) notices across different hospital Trusts in England and Wales, and the Resuscitation Council (UK) has recently proposed a standard approach for how DNACPR notices can be better incorporated into overall care plans. However, the Council can only make recommendations for good practice. This discussion reviews current practices and suggests that the time has come for a national standardized approach to the process of initiating and documenting DNACPR, along with a dedicated programme to increase public understanding of what is involved. A national policy framework for DNACPR notices would avoid regional and institutional differences, bust current myths, and ensure communication with, and involvement of, the patient remains at the heart of medical practice and decision-making. Importantly, it would both ensure that the respective legal rights and obligations of patients and professionals are respected, as well as providing clear public health benefits. At the very least, a national conversation would help achieve common understandings and expectations

Reading disability in literature and in film

This is a review-article of two major studies in disability studies, one edited collection, The Problem Body: Projecting Disability on Film, edited by Sally Chivers and Nicole Markotić and one authored volume, Aesthetic Nervousness: Disability and the Crisis of Representation by Ato Quayson.peer-reviewe