Clin Med
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Practice Guideline
Emergency treatment of anaphylaxis in adults: concise guidance.
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction characterised by rapidly developing life-threatening airway, breathing and/or circulation problems usually associated with skin and mucosal changes. Updated guidance on the recognition, acute management and follow up of adults with anaphylaxis has recently been published. This is a concise version of the full guidelines published by the Resuscitation Council (UK) in 2008. The use of an airway, breathing, circulation, disability and exposure approach to recognise and treat anaphylaxis is emphasised.
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Significant hypercalcaemia can cause electrocardiogram (ECG) changes mimicking an acute myocardial infarction. It is important to recognise that some ECG changes are due to conditions other than cardiac disease so that appropriate treatment is given, and importantly, inappropriate treatments are avoided.
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Comparative Study
Assessment centres for core medical training: how do the assessors feel this compares with the traditional interview?
In 2007, an assessment centre approach (a structured interview, a case-based discussion and a communication exercise) was implemented to replace the traditional interview for entry to core medical training. Feedback was obtained from 53 of 69 assessors, all consultants and most with extensive experience of the traditional system. Each station was rated by around 20 interviewers. ⋯ Comparison with the previous system was only provided by between 12 and 21 people per station. The structured interview was rated better (n=12), undecided (8), or worse (1); the case-based discussion better (16), or undecided (3); the communication station better (8), undecided (3), or worse (1). There is still work to do on the best components to include but the principle of multiple assessments to examine differing parts of the person specification seems, subjectively, to be supported.
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Studies have shown that end-of-life care within the UK hospital setting is variable, and care pathways are now being advocated in the UK. This report presents results from an audit revealing that it is possible to anticipate a large proportion of deaths within an acute setting, but this is generally achieved very close to the end of life. ⋯ It discusses the challenges around making the 'diagnosis of dying' and highlights that if clinicians do not feel confident in performing such a diagnosis, then patients cannot benefit from end-of-life care pathways. Instead of asking healthcare professionals to make accurate prognoses or diagnose dying, an environment needs to be created where teams feel comfortable in actively managing patients (appropriately) alongside considering their symptom control and planning for possible end-of-life care.
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Climate change was originally expected to have its main impact on countries in temperate latitudes which, because of their relative wealth, would be best able to cope. It is now far more likely that much poorer states in the tropics and sub-tropics will experience severe impacts. ⋯ The dangerous response to the prospects of mass migration and radical social movements is to attempt to maintain control without addressing underlying problems. Instead, there is an urgent need to embrace new concepts of sustainable security.