Clin Med
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Case Reports
Transfusion-related acute lung injury: a rare and life-threatening complication of a common procedure.
Transfusion-related acute lung injury (TRALI) has emerged as one of the leading causes of transfusion-related morbidity and mortality and is undoubtedly under diagnosed. It is a serious pulmonary syndrome that can lead to death if not recognised and treated promptly. The diagnosis of TRALI is based primarily upon clinical signs and symptoms and is, in part, a diagnosis of exclusion.
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This article summarises findings from studies of career choices made for the hospital medical specialties by medical graduates one, three and five years after qualifying from UK medical schools in selected years from 1974 to 2005. The percentage of doctors who, early in their careers, expressed a preference for the hospital medical specialties declined between the 1970s and 1980s, increased during the 1990s, and has stabilised since then. ⋯ Compared with doctors who choose other specialties, a higher percentage of doctors who choose the hospital medical specialties are uncertain about their specialty choice in the early years after qualification. This uncertainty needs to be considered by those planning postgraduate medical education for the hospital medical specialties, particularly now that postgraduate training in the UK has become much more structured.
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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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The modified early warning score (MEWS) was developed as a track and trigger tool for the prompt identification of seriously ill patients on an acute medical ward. This paper examines its value in the setting of an acute medical admissions unit (MAU) and compares it to biochemical markers of acute and chronic disease. Three hundred unselected acute admissions to the MAU of the Queen Elizabeth Hospital, Gateshead, were assessed. ⋯ A raised CRP/albumin ratio was less sensitive for overall mortality than MEWS. It did, however, appear to be of greater value in the elderly, especially in those with acute exacerbations of chronic disease. Neither test accurately predicted length of stay.