Clin Med
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Comparative Study
The impact of consultant-delivered multidisciplinary inpatient medical care on patient outcomes.
Consultant-delivered care has been shown to improve outcomes for acute medical patients. However, the ideal composition of a medical team to support consultant-delivered care is not clear and little is known about the effect of continuing consultant-delivered care until the patient is discharged. ⋯ No difference between the groups was seen for readmission rates, patient safety or mortality. In conclusion, a CD-MDT is a safe and effective model of inpatient medical care and is associated with a shorter length of hospital stay.
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Conservative care is one of the fastest-changing areas of renal medicine. Non-dialytic therapy is now established as a treatment option in most renal units in the UK. This conference reviewed the history of conservative management and examined the state of current practice. The challenges now faced include expanding the evidence base in this area, improving the information given to patients and their families to help them make a decision about treatment, and responding to changes in NHS funding to ensure continued provision of high-quality care.
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Increasing the number of organ transplants is a priority for most governments. While potential new legislation for donor registration, such as the Welsh Government white paper on establishing an opt-out system for Welsh residents, is the focus of most ethical and legal scrutiny, there are also other approaches to increase the number of patients receiving organ transplants. The then National Institute for Health and Care Excellence (NICE) published guidance on this issue in 2011, but subsequent debate in this journal has suggested that the guidance was presumptuous and might encourage unethical practice. This paper addresses these concerns and concludes that the NICE guidance provides a legal, ethical and clinically relevant way forward in a complex and developing public health issue.
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Thoracic ultrasound training has become part of the respiratory medicine curriculum. Data on training, access to teaching and achievement of competency in thoracic ultrasound by respiratory specialty trainees are scarce. Using the web-based kwiksurveys, we surveyed current respiratory specialty trainees (STs) in the UK. 177 responses were recorded. ⋯ Overall, 28.8% had achieved level 1 competency but only 44.4% of trainees at ST6 and above were level 1 competent. The majority of respiratory trainees have access to thoracic ultrasound but structured training is limited, with only a small proportion of trainees attaining level 1. More structured training and mentoring is needed to enable trainees to achieve the required competencies.