The next generation of physicians.
PMID: 25468836 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Black D Tags: Clin Med Source Type: research
Presumed consent for organ donation: a clinically unnecessary and corrupting influence in medicine and politics.
Abstract
Presumed consent is a legislative framework in which citizens must place their name on a national opt-out register, otherwise their consent for donating their organs will be presumed. The Welsh Assembly last year passed legislation to enable the introduction of presumed consent in Wales in 2015. The issue is currently being discussed in Northern Ireland, Scotland and the Republic of Ireland. However, there is scant evidence that presumed consent will be effective. Rather than legislating for consent of donors, we should be addressing the misgivings and misunderstandings of families to improve thei...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Fabre J Tags: Clin Med Source Type: research
DNACPR decisions: challenging and changing practice in the wake of the Tracey judgment.
Abstract
The Court of Appeal judgment that Janet Tracey's human rights had been breached when a 'do not attempt cardiopulmonary resuscitation' (DNACPR) form was written about her without her knowledge has far-reaching implications for clinical practice. The 'duty to consult' extends to all patients apart from those in whom it is likely that discussion would cause 'physical or psychological harm'. The ethical basis for this judgment is strong: if a patient is unaware that a resuscitation decision has been made, he or she cannot ask questions, plan the future or ask for second opinions. Clinicians have, howe...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Fritz Z, Cork N, Dodd A, Malyon A Tags: Clin Med Source Type: research
Lessons learnt from a pilot of assessment for learning.
Abstract
A 12-month pilot was carried out on assessments for learning and assessments of learning as part of workplace-based assessments in postgraduate medical education. This was carried out in three regions and core medical trainees and higher specialty medical trainees participated. Focus groups and questionnaires were utilised to investigate the trainees' and trainers' experiences and perceptions of assessments for learning. The study demonstrated that the trainees and trainers perceived the newly introduced assessments for learning - supervised learning events (SLEs) - as learning tools. However, SLE...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Cho SP, Parry D, Wade W Tags: Clin Med Source Type: research
Doctors' experiences of adverse events in secondary care: the professional and personal impact.
Abstract
We carried out a cross-sectional online survey of fellows and members of the Royal College of Physicians to establish physicians' experiences of adverse patient safety events and near misses, and the professional and personal impact of these. 1,755 physicians answered at least one question; 1,334 answered every relevant question. Of 1,463 doctors whose patients had an adverse event or near miss, 1,119 (76%) believed this had affected them personally or professionally. 1,077 (74%) reported stress, 995 (68%) anxiety, 840 (60%) sleep disturbance and 886 (63%) lower professional confidence. 1,192 (81%...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Harrison R, Lawton R, Stewart K Tags: Clin Med Source Type: research
A new future for hip fracture care - orthogeriatrician lead in an 'Acute' Hip Unit.
Abstract
Although surgery is the definitive treatment for almost all hip fractures, there is evidence that outcomes such as morbidity and mortality are not determined by the type of surgery but by comorbidities and postoperative complications. A team approach, especially the involvement of an orthogeriatrician in managing medical issues, has been shown to improve surgical outcomes and should be encouraged in hospitals worldwide. An Acute Hip Unit is able to address the complex challenging needs of a frail older high-risk population soon after admission, therefore minimising delays. An orthogeriatrician-led...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Gupta A Tags: Clin Med Source Type: research
Effects of diagnostic uncertainty and misclassification on hospital performance indicators for acute stroke care.
Abstract
The Stroke Improvement National Audit Programme (SINAP), now replaced by the Sentinel Stroke National Audit Programme, was established to provide comparative data on hospital performance indicators for stroke, but comparisons are only valid if case ascertainment is complete. In Gateshead we compared initial results from SINAP with those from a pre-existing hospital stroke register, which ran independently for 11 months after SINAP's introduction in 2010, as well as with Hospital Episode Statistics (HES) data. Of 315 confirmed acute stroke cases identified from the three combined data sources, 96 (...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Barer D, Cassidy T Tags: Clin Med Source Type: research
Lessons about food anaphylaxis.
Abstract
Exercise-induced anaphylaxis (EIA) and its subtype food-dependent (FD)-EIA are uncommon and easily missed forms of physical allergy. The latter is triggered by exercise following the ingestion of specific food products. Treatment is identical to that for IgE-mediated allergic reactions. The disease is potentially fatal. In this case, 30-year-old woman was seen in the allergy clinic at the request of her general practitioner. She reported an episode when she had gone to a local park to exercise after dinner. Shortly thereafter, she collapsed with rash, lip swelling, and breathing difficulties. Upon...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Medveczky T Tags: Clin Med Source Type: research
Perioperative beta-blockade: might the baby go out with the bath water?
Abstract
Perioperative β-blocker therapy has been advocated to reduce cardiac mortality and morbidity in high-risk cardiac patients undergoing non-cardiac surgery. Core data that supported this intervention and informed international societal guidelines has recently been withdrawn. A subsequent meta-analysis of the remaining data reporting excess mortality has re-opened the debate about the utility of β-blocker therapy in the perioperative period. Criticism of remaining trial designs and new insights into the protective mechanisms of β-blocker therapy in critical illness raise important questions that s...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Mistry R, Walker D Tags: Clin Med Source Type: research
Point-of-care cardiac ultrasound in acute medicine - the quick scan.
Abstract
The optimum management of acute medical patients requires prompt and accurate diagnosis, monitoring and treatment. The clinical history and physical examination remain central to diagnosis, but often need supplementation by laboratory testing or imaging. Echocardiographic assessment of cardiac structure and function provides valuable information that can aid diagnosis and assess clinical progress. It has many advantages as an imaging modality, and recent technological advances have resulted in hand-held, battery-powered ultrasound devices that provide high-quality images. Three broad applications ...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Hothi SS, Sprigings D, Chambers J Tags: Clin Med Source Type: research
Improving core medical training - innovative and feasible ideas to better training.
This article draws together some of these excellent ideas on how the quality of training and the experience of trainees could be improved. It presents a vision for how CMT trainees, consultant supervisors, training programme directors, clinical directors and managers can work together to implement relevant, feasible and affordable ways to improve training for doctors and deliver the best possible care for patients.
PMID: 25468846 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Tasker F, Dacombe P, Goddard AF, Burr B Tags: Clin Med Source Type: research
Adolescents and young adults on the acute medical unit: how might we do it better?
Abstract
It is a common perception that young people do not become ill and do not pose a challenge in the unscheduled healthcare setting. The research, however, increasingly suggests that young adults and adolescents (YAAs) are a highly vulnerable group, with poorer outcomes than either older adults or children, and distinct healthcare needs. The acute medical unit (AMU) setting poses particular challenges to the care of this patient group. To improve care and patient experience, adult clinicians need to look critically at their services and seek to adapt them to meet the needs of YAAs. This requires coope...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Albon L, Vaughan L Tags: Clin Med Source Type: research
Insulin for the uninitiated.
Abstract
Insulin therapy is important in many patients with diabetes, but the UK National Diabetes Inpatient Audit (NaDIA) suggests that insulin therapy in hospital is poorly monitored and managed. Although most hospitals should have access to an inpatient diabetes specialist team, it is important for the non-specialist clinician to be aware of the indications for insulin therapy, types of insulin and insulin regimens, methods of adjusting insulin doses and the need for care with insulin prescribing. Here, we demystify issues around insulin therapy.
PMID: 25468848 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Chowdhury TA, Wright R, Charlton M Tags: Clin Med Source Type: research
Medical migration within Europe: opportunities and challenges.
Abstract
The free movement of European citizens to live and work within the European Union (EU) is one of the fundamental pillars of the European single market. Recent EU legislation on the recognition of professional qualifications (to take effect January 2016) updates the framework within which doctors and others can migrate freely between EU member states to practise their profession. UK organisations lobbied extensively to change aspects of the original proposals, in particular those that threatened to 'water down' public protection in the interest of free movement. The legislation finally adopted sign...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Ling K, Belcher P Tags: Clin Med Source Type: research
How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?
Abstract
This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifications. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to stan...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Solé M, Panteli D, Risso-Gill I, Döring N, Busse R, McKee M, Legido-Quigley H Tags: Clin Med Source Type: research
