Clin Med
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Eight years' experience of regional audit: an assessment of its value as a clinical governance tool.
Strengthening clinical audit is crucial for improving the quality of healthcare provision. The West Midlands Rheumatology Service and Training Committee coordinates an innovative programme of regional audits and the experience of rheumatology healthcare professionals involved was surveyed. This was a questionnaire-based study in which respondents rated statements relating to regional audit on Likert scales. ⋯ Many units reported changes in practice. Regional audit is widely perceived to be a valuable clinical governance tool supporting significant changes to clinical practice, and an excellent training opportunity for SpRs. Recommendations for a successful regional audit scheme are described in this article.
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Review
Management of acute exacerbations of chronic obstructive pulmonary disease: the first 24 hours.
Successful outcome is more likely with early treatment and lesser degrees of acidosis. While aiming for maximum treatment for the first 24 hours, some patients improve so rapidly that they can discontinue after a shorter time. Most patients need a full face mask and oxygen, and nebulised bronchodilators can be incorporated. ⋯ Patients can often be quickly weaned on to NIV and returned to the ward after an initial period of invasive support and secretion management. Initial assessment and the past history should identify those markedly disabled patients with recurrent admissions who are likely to be entering the terminal stages of their illness in whom intubation is inappropriate. Here, NIV may be the ceiling of treatment, providing useful symptom palliation while waiting for treatment to