Postgraduate medical journal
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Chest x rays (CXRs) are among the most difficult radiographs to interpret accurately. The aim of this study was to assess the ability of different grades and specialities of clinicians to evaluate a series of CXRs correctly. ⋯ To improve patient care, we suggest that all chest x rays should be reviewed at an early stage during a patient's hospital admission by a senior clinician and reported by a radiologist at the earliest opportunity. We also suggest that structured teaching on CXR interpretation should be made available for newly qualified doctors, especially with the introduction of shortened training.
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Multicenter Study
Prescription writing skills of residents in a family practice residency programme in Bahrain.
To evaluate the prescription writing skill of final year residents in a family practice residency programme (FPRP) in Bahrain, and to compare skill of residents who have graduated from medical schools with problem based learning (PBL) versus traditional (non-PBL) curricula. ⋯ Prescription writing skill of the final year residents in an FPRP programme was suboptimal for both PBL and non-PBL graduates. Integration of prescription writing skill and a rational pharmacotherapeutic programme into the FPRP curriculum is recommended.
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Multicenter Study
Transition from CK-MB to troponin did not improve the 1 year mortality of non-ST elevation acute coronary syndromes.
To examine the hypothesis that transition from creatine kinase MB subunits (CK-MB) to troponin as a more sensitive biomarker of myocardial necrosis reduced the 1 year mortality of non-ST elevation acute coronary syndrome (ACS) patients. ⋯ Transition to troponin as a diagnostic marker of MI led to an increase in the incidence of non-ST elevation MI. This transition was not associated with a decrease in the 1 year non-ST elevation ACS mortality rate.
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Multicenter Study
Polymorbidity in diabetes in older people: consequences for care and vocational training.
To investigate the prevalence of complicating and concurrent morbidities in older diabetic patients and to evaluate to what extent their occurrence affects the burden of disease and use of medical healthcare. ⋯ The use of healthcare facilities by older patients with diabetes is substantial, irrespective of the complexity of the disease and the kind of practice involved. The common manifestation of complicating and concurrent comorbidities and their varying complexity in individual patients requires a patient-oriented rather than a disease-oriented approach and vocational training programmes for care givers that are tailored to the complexity of multiple chronic diseases.
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Multicenter Study
Evaluation of the need for endoscopy to identify low-risk patients presenting with an acute upper gastrointestinal bleed suitable for early discharge.
To audit the safety of differing protocol-driven early-discharge policies, from two sites, for low-risk acute upper gastrointestinal (GI) bleeding and determine if default early (<24 h) in-patient endoscopy is necessary. ⋯ Patients admitted with a low-risk acute upper GI bleeding can be managed safely by a nurse-led process-driven protocol, based on readily available clinical and laboratory variables, with early discharge <24 h. Avoiding in-patient endoscopy appears to be safe but at the price of greater clinic follow-up.