What makes a good clinical app? Introducing the RCP Health Informatics Unit checklist.
Abstract
Doctors increasingly rely on medical apps running on smart phones or tablet computers to support their work. However, these apps vary hugely in the quality of their data input screens, internal data processing, the methods used to handle sensitive patient data and how they communicate their output to the user. Inspired by Donabedian's approach to assessing quality and the principles of good user interface design, the Royal College of Physicians' Health Informatics Unit has developed and piloted an 18-item checklist to help clinicians assess the structure, functions and impact of medical apps. Use ...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Wyatt JC, Thimbleby H, Rastall P, Hoogewerf J, Wooldridge D, Williams J Tags: Clin Med Source Type: research
Management of high-risk non-ST elevation myocardial infarction in the UK: need for alternative models of care to reduce length of stay and admission to angiography times.
Abstract
The roll out of the primary percutaneous coronary intervention pathway as the default treatment for patients with ST elevation myocardial infarction (STEMI) across the NHS has led to a paradigm shift in the model of care resulting in a significant improvement in mortality. In comparison, a similar care plan does not exist for non-ST elevation acute coronary syndrome (NSTE-ACS) despite the fact that patients presenting with high-risk non-STEMI carry a similar if not higher mortality at six months in comparison to STEMI. In this article we focus on the contemporary management of NSTE-ACS in the NHS ...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Koganti S, Rakhit RD Tags: Clin Med Source Type: research
Improvements in the management of neutropenic sepsis: lessons learned from a district general hospital.
Abstract
Neutropenic sepsis is a life-threatening condition with mortality rates reported to range between 2 and 21% in adults. It can occur following chemotherapy treatment, due to disease (such as haematological conditions affecting the bone marrow) and in patients on disease-modifying agents (such as patients receiving methotrexate for rheumatoid arthritis). Appropriate emergency treatment is essential and achieving intravenous antibiotic door-to-needle time of less than 1 hour is a key target. Shortfalls in the management of patients presenting to teams with limited expertise in this area were identif...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Wells T, Thomas C, Watt D, Fountain V, Tomlinson M, Hilman S Tags: Clin Med Source Type: research
The Royal College of Physicians' Fallsafe care bundles applied trustwide: the Northumbria experience 2013.
Abstract
The Royal College of Physicians' FallSafe care bundles constitute measures of good practice, some of which are recommended for all patients, some are additional measures for older and more vulnerable patients admitted to hospital, and there is another bundle for after an inpatient fall, to reduce the number of inpatient falls. In 2013 a dedicated healthcare assistant, trained by the falls team, started a monthly spot audit looking at preventative measures, on all inpatients on every ward of the trust. Monthly results were fed back to the ward managers, ward falls liaison nurses, doctors, therapist...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Richardson DA, Bhagwat A, Forster K, Hibbert R, Robertson L, Whitelaw P, McArdle A, Thompson E Tags: Clin Med Source Type: research
Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?
This study evaluates the efficacy of low-fat dietary interventions in the management of gastrointestinal (GI) symptoms due to bile acid malabsorption. In total, 40 patients with GI symptoms and a 7-day (75)selenium homocholic acid taurine (SeHCAT) scan result of <20%, were prospectively recruited and then advised regarding a low-fat dietary intervention. Before and after dietary intervention, patients rated their GI symptoms using a 10-point numerical scale, and recorded their intake in 7-day dietary diaries. After dietary intervention, the median scores for all GI symptoms decreased, with a significant reduction for ur...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Watson L, Lalji A, Bodla S, Muls A, Andreyev HJ, Shaw C Tags: Clin Med Source Type: research
Sticks and stones: investigating rude, dismissive and aggressive communication between doctors.
Abstract
Destructive communication is a problem within the NHS; however previous research has focused on bullying. Rude, dismissive and aggressive (RDA) communication between doctors is a more widespread problem and underinvestigated. We conducted a mixed method study combining a survey and focus groups to describe the extent of RDA communication between doctors, its context and subsequent impact. In total, 606 doctors were surveyed across three teaching hospitals in England. Two structured focus groups were held with doctors at one teaching hospital. 31% of doctors described being subject to RDA communica...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Bradley V, Liddle S, Shaw R, Savage E, Rabbitts R, Trim C, Lasoye TA, Whitelaw BC Tags: Clin Med Source Type: research
What is the quality of smoking cessation advice in guidelines of tobacco-related diseases?
Abstract
Smoking is a major risk factor for a range of diseases, and quitting smoking provides considerable benefits to health. It therefore follows that clinical guidelines on disease management, particularly for diseases caused by smoking, should include smoking cessation. The aim of this study was to determine the extent to which this is the case. We conducted a systematic review investigating clinical guidelines and recommendations issued by UK national or European transnational medical speciality associations and societies issued between 2000 and 2012 on a range of diseases caused by smoking. We then ...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Bogdanovica I, Agrawal S, Gregory B, Britton J, Leonardi-Bee J, Tobacco Advisory Group of the Royal College of Physicians Tags: Clin Med Source Type: research
Drug therapies to delay the progression of chronic kidney disease.
Abstract
Chronic kidney disease (CKD) is associated with significant morbidity and mortality, impacted not alone by progression to end-stage kidney disease, but also by the high associated incidence of cardiovascular events and related mortality. Despite our current understanding of the pathogenesis of CKD and the treatments available, the reported incidence of CKD continues to rise worldwide, and is often referred to as the silent public healthcare epidemic. The significant cost to patient wellbeing and to the economy of managing the later stages of CKD have prompted efforts to develop interventions to de...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Ward F, Holian J, Murray PT Tags: Clin Med Source Type: research
Faints, fits and funny turns for the physician.
Abstract
The diagnosis and management of the dizzy patient presents the physician with significant challenges. Dizziness and imbalance are common complaints among the general population, affecting around one-third of people over the age of 65 years, and can result from a range of causes spanning many medical disciplines. The ability to take a thorough, accurate history with a logical framework for formulating a differential diagnosis is essential given the many ways that symptoms of dizziness can present. An understanding of the key features of the vestibular examination, and consideration of other pathol...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Omar R Tags: Clin Med Source Type: research
An IVF pregnancy, a neck lump and shortness of breath.
We present the case of a young primigravida, conceived with in vitro fertilisation, referred with unilateral neck swelling and pleuritic chest pain. Our case highlights the potential complexity of the management of the complications of assisted conception techniques. The discussion explores important considerations in the management of such patients.
PMID: 26621946 [PubMed - as supplied by publisher] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Petrie KF, Carter RM, Sadighi A, Choong AM, Davies AH, Wong A Tags: Clin Med Source Type: research
Sexual health issues in adolescents and young adults.
PMID: 26621947 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Forsyth S, Rogstad K Tags: Clin Med Source Type: research
Tackling emerging infections: clinical and public health lessons from the West African Ebola virus disease outbreak, 2014-2015.
PMID: 26621948 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Walker NF, Whitty CJ Tags: Clin Med Source Type: research
UK medical selection: lottery or meritocracy?
PMID: 26621949 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Harris BH, Walsh JL, Lammy S Tags: Clin Med Source Type: research
Conservative care of the patient with end-stage renal disease.
Abstract
'Conservative care' is the management of end-stage kidney disease without dialysis, ie a palliative approach. It is now well established as the fourth treatment option alongside haemodialysis, peritoneal dialysis and transplantation, in the majority of UK renal centres.
PMID: 26621950 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Alston H, Burns A Tags: Clin Med Source Type: research
HIV and the kidney in the acute medical unit.
This article provides an overview of common causes of AKI in HIV and presents a framework by which the acute care physician may approach the finding of an elevated serum creatinine in a patient with HIV.
PMID: 26621951 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Booth JW, Post FA Tags: Clin Med Source Type: research
