Clin Med
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Fatigue and stress-related illnesses often become diagnoses of exclusion after extensive investigation. 'Tired all the time' is a frequent reason for referral to the endocrine clinic, the implicit question being--is there a subtle endocrine pathology contributing to the patient's symptoms? Often initial assessment suggests not but there are no clear data to address the question of whether overt pathology will develop in the future. This study observed outcomes after five years in 101 consecutive and unselected referrals to secondary care for 'fatigue?cause', where initial assessment did not suggest treatable endocrine pathology. The findings suggest that the clinical diagnosis of fatigue, based on history and tests to exclude anaemia, hypothyroidism and diabetes, is secure: these patients do not subsequently demonstrate excess morbidity and mortality, and their presenting symptoms are not early features of significant endocrine pathology.
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The decision to perform cardiopulmonary resuscitation (CPR) remains one of the most important and difficult decisions a physician must make. This study examined differences in CPR decision making among senior hospital clinicians. A questionnaire was sent out to consultants and specialist registrars in general medicine, elderly care and intensive care in a large UK district general hospital, with anonymous returns. ⋯ There were significant differences between specialties in making the decision to perform CPR and the confidence in doing so, with three cases producing polarised results within the specialties, despite equal confidence in the decision. There is lack of consensus with the CPR decisions made between specialties and within them. Formal training in recognition of futility should be encouraged for all clinicians.
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Healthcare chaplaincy research seems further advanced in the USA. Here a US patient satisfaction with chaplaincy instrument (PSI-C-R) was used in a London NHS foundation hospital with a multi-faith chaplaincy team and population. A version of the instrument was also generated for the bereaved. ⋯ It proved only partly reliable, but in three separate surveys a cluster of highly rated factors emerged, as in earlier studies: chaplains' prayer, competence, listening skills and spiritual sensitivity. Low-rated factors and qualitative data highlighted areas for improvement. Disappointing response rates arose from patient acuity, ethical concerns about standard follow-up protocols, and the Western Christian origins of the instrument which requires further revision for multi-faith settings, or the design of new instruments.