International journal of clinical practice
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Int. J. Clin. Pract. · Mar 2009
ReviewDying in an acute hospital setting: the challenges and solutions.
More than half of all UK deaths occur in hospital, yet evidence suggests that the quality of inpatient end of life care is suboptimal at best. Over half of all NHS complaints pertain to problems with care in the dying phase, particularly with regard to poor communication. This is a hugely topical area following the recent publication of the Department of Health's End of Life Care Strategy. With reference to current literature, we seek to investigate the challenges associated with providing 'a good death' in hospital and construct a framework of strategies for improvement; including communication skills training, use of integrated care pathways, advance planning, educational initiatives and the role of the palliative care team.
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Int. J. Clin. Pract. · Mar 2009
Review Comparative StudyCost-effectiveness analysis of linezolid vs. vancomycin in treating methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections using a decision analytic model.
To evaluate the cost-effectiveness of vancomycin vs. linezolid in complicated skin and soft tissue infections (cSSTIs) with methicillin-resistant Staphylococcus aureus (MRSA) using a decision analytic (DA) model. ⋯ Alternative vancomycin strategies (VAN-2 and VAN-3) that take advantage of early discharge opportunities were cost-effective compared with LIN. However, LIN's higher efficacy would make it cost-effective for payers with a high WTP threshold.
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The worldwide prevalence of chronic obstructive pulmonary disease (COPD) is growing faster in women than in men. Over the past two decades, COPD-related mortality rates have also grown faster in women, and since the year 2000 more women than men have died from COPD. The greater prevalence of COPD and related mortality reported for men in earlier epidemiological studies may be due to under-diagnosis of women. ⋯ Despite these differences, the current guidelines for the diagnosis and treatment of men or women with COPD are the same. It is important for healthcare professionals to recognise the gender differences in patients with COPD to optimise assessment, monitoring and treatment of this disease. This article reviews the clinical differences between men and women with COPD, current treatment guidelines and its implications for improvement in the management of women with COPD.