Clin Med
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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.
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Takotsubo cardiomyopathy (TCM) is an unusual form of acute cardiomyopathy showing left ventricular apical ballooning. TCM can masquerade as ST elevation myocardial infarction (STEMI). ⋯ In patients with hypotension and moderate-to-severe left ventricular outflow tract (LVOT) obstruction, inotropic agents should be avoided, because they can worsen the degree of obstruction. Instead, beta-blockers are preferred, because they are capable of resolving the obstruction and consequently improve the haemodynamics.
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The NHS is arguably entering its most challenging era. It is being asked to do more for less and, in parallel, a cultural shift in response to its described weaknesses has been prescribed. ⋯ Identification of leaders within the workforce and dissemination of a purposeful and strategic quality improvement agenda, in part defined by the general workforce, are important components in establishing the change that the organisation currently requires. We are implementing this approach locally by identifying and developing grassroots networks linked to a portfolio of safety and quality projects.