Clin Med
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Nutrition and fluid and electrolyte balance are inextricably linked through ingestion, digestion, absorption and intermediary metabolism. Studies are described showing that man's physiological capacity to excrete excess salt and water is limited under normal conditions; it is further reduced by starvation and injury, so that patients are easily overloaded, resulting in increased complications of illness and surgery. Return of gastrointestinal function postoperatively is delayed by moderate saline overload. ⋯ The relationships between serum albumin concentration, illness, nutrition and fluid balance are discussed and the limited role of albumin infusions described. Surveys among doctors have revealed a poor knowledge of fluid and electrolyte balance. Measures are needed to improve training.
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Individuals who fall asleep at the wheel usually do so because they are sleep deprived. It is likely that they are aware of the circumstances leading to sleepiness and of feeling sleepy before the event. ⋯ In this context, the Department for Transport brought together a group to explore the potential significance of sleep disorders in accidents. The Driver and Vehicle Licensing Agency has clarified existing regulations, particularly those that concern vocational drivers.
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We audited documentation rates and implementation of cardiopulmonary resuscitation (CPR) decisions for patients admitted under the Department of Elderly Care Medicine, Mayday University Hospital, Croydon, as new guidelines and a proforma were introduced. For the first audit, data were collected from 75 departmental discharges. Following introduction of a proforma, six point prevalence audits were performed of all elderly care inpatients. ⋯ There was no significant difference in age, diagnosis, cognitive function or disability between patients in those audits (3-7) when these parameters were recorded. Introducing a proforma significantly improved CPR decision documentation. Obligatory discussion with a patient before issuing a DNAR order was associated with a fall in documentation of decisions.