Clin Med
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The slow epidemic of liver disease in the UK over the past 30 years is a result of increased consumption of strong cheap alcohol. When we examined alcohol consumption in 404 subjects with a range of liver disease, we confirmed that patients with alcohol-related cirrhosis drank huge amounts of cheap alcohol, with a mean weekly consumption of 146 units in men and 142 in women at a median price of 33p/unit compared with £1.10 for low-risk drinkers. For the patients in our study, the impact of a minimum unit price of 50p/unit on spending on alcohol would be 200 times higher for patients with liver disease who were drinking at harmful levels than for low-risk drinkers. As a health policy, a minimum unit price for alcohol is exquisitely targeted at the heaviest drinkers, for whom the impact of alcohol-related illness is most devastating.
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Rehabilitation medicine is an educational, problem-solving specialty that relies on excellent team communication, honest discussion with patients and their families, and collaborative goal setting. The case conference has been described as the technology of rehabilitation medicine because it encompasses all of these functions. Trainees should have the opportunity to develop skills in chairing case conferences through receipt of constructive feedback on their performance from their trainers. ⋯ Following feedback from the workshops, a final version of the cCAT was developed. The cCAT has now been adopted as a workplace-based assessment for specialty trainees in rehabilitation medicine by the Training Board of the Joint Royal Colleges of Physicians. Further work will explore its utility for trainees in other specialties and in communication and leadership skill training for undergraduate students.
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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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The abuse of adults who are vulnerable or at risk is an important cause of harm to patients. Doctors have a duty to act on concerns about abuse and to seek to protect those in need. We discuss two case examples of how abuse can present in a general hospital setting and use these to consider the steps clinicians should take in the interests of patients. We also describe definitions in relation to safeguarding adults and illustrate principles with which to approach safeguarding practice.