Clin Med
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This study aimed to evaluate timeliness of an outpatient urgent access neurovascular clinic in a district general hospital setting through an audit of delay from event to completion of evaluation following transient ischaemic attack (TIA) or minor stroke. Participants included those referred for evaluation of suspected TIA or minor stroke. ⋯ A weekly TIA clinic is not capable of achieving the National Clinical Guidelines for Stroke recommendation for evaluation within one week of symptoms. This audit supports the National Stroke Strategy recommendation for immediate evaluation of patients presenting with a recent TIA or minor stroke.
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A cornerstone of the development of acute medicine has been the principle of consultant presence within the acute medical unit (AMU). There is the hypothesis that consultant supervision improves patient care. This view is not currently supported by firm scientific evidence. ⋯ Overall length of stay was significantly lower, by a mean of 1.3 days, when there was a consultant present, and 9% more patients were discharged on the same day of their assessment (95% confidence interval 5.7% to 12.6%, p < 0.001) without affecting readmission or mortality. These results suggest the absence of a consultant leads to fewer same-day discharges and causes the inappropriate admission of patients not needing inpatient management. Further study is required to determine whether these findings are shared by other AMUs.
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Chest drain insertion may have unintended consequences; this procedure should only be carried out when there are clear indications to do so.
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Mitigating climate change presents unrivalled opportunities for improving public health. The policies that need to be implemented to reduce greenhouse gas emissions will also bring about substantial reductions in heart disease, cancer, obesity, diabetes, road deaths and injuries, and air pollution. ⋯ Because the existence of important health co-benefits will dramatically reduce the cost to society of taking strong action to mitigate climate change, failure to appreciate their importance could have serious environmental consequences. Health professionals have an urgent responsibility to ensure that the health benefits of environmental policies are understood by the public and by policymakers.