Clin Med
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Historical Article
Intensive care medicine is 60 years old: the history and future of the intensive care unit.
Intensive care is celebrating its 60th anniversary this year. The concept arose from the devastating Copenhagen polio epidemic of 1952, which resulted in hundreds of victims experiencing respiratory and bulbar failure. ⋯ By 1953, Bjorn Ibsen, the anaesthetist who had suggested that positive pressure ventilation should be the treatment of choice during the epidemic, had set up the first intensive care unit (ICU) in Europe, gathering together physicians and physiologists to manage sick patients - many would consider him to be the 'father' of intensive care. Here, we discuss the events surrounding the 1952 polio epidemic, the subsequent development of ICUs throughout the UK, the changes that have occurred in intensive care over the past 10 years and what the future holds for the specialty.
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This concise guidance comprises a distillation of recommendations for the diagnosis and management of epilepsies for non-specialists and is based on updated clinical guideline 137 published by the National Institute of Health and Care Excellence (NICE). It is intended to provide the generalist at the front line (particularly but not exclusively in the acute hospital setting) with an accessible and up-to-date outline of key guidance on assessment, clinical management, communication and referral. Recommendations abstracted verbatim from the guideline are highlighted. Brief explanatory or supporting comment is given where appropriate.
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Although motor fluctuation can often be severe in Parkinson's disease (PD), it is rare for an 'off period' to result in coma. The case presented here is of a patient with longstanding PD who was admitted to our hospital with a Glasgow Coma Scale of three after missing just one or two doses of her medication. ⋯ This case highlights how florid the presentation of motor fluctuations in PD can be and the importance of restarting treatment as quickly as possible. Guidance is provided on how to administer dopaminergic medications in patients who are unable to swallow.
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Effects of experimental inductions for newly qualified doctors on competence at clinical procedures.
Up to 96% of newly qualified doctors fail one or more clinical procedure tests. Their entrance into work in hospitals has been associated with significant reductions in patient safety and an increase in patient mortality. Curriculum changes offer one solution. ⋯ Experiments reported in the literature showed improvements in new doctors' competence at intravenous line insertion and taking blood after a 5-day or 2-week induction, intravenous drug administration after a 5-day induction, certifying death, prescribing and out-of-hours tasks after a 2-week induction, and lumbar puncture and spirometry after a 1-day induction. Examined performance after a 5-day induction also showed improved objective structured clinical examination (OSCE) scores on blood pressure, cannulation, venepuncture and catheterisation. There is therefore value in scheduling inductions before doctors report for their first day on the job.