Clin Med
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Multicenter Study Comparative Study
Getting the basics right: delays in phlebotomy and intravenous cannulation: a survey of foundation year 1 doctors.
Junior doctors frequently experience delays in routine ward-based procedures. There is little published data on this subject, but it is clear that such delays can have implications in terms of costs, efficiency, length of patient stay, team working and patient safety and experience. We formulated an anonymous online survey to quantify the experiences of foundation year 1 (FY1) doctors with respect to phlebotomy services and intravenous (IV) cannulation. ⋯ For IV cannulation, 21% of doctors reported equipment availability as 'very good', but only 3% said that they were able to find all of the pieces of equipment they needed close to each other ('essentially in the same place'). Similar results were obtained for phlebotomy. Nevertheless, there appears to be significant room for improvement and we offer recommendations to address delays.
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Despite efforts, the detection of patients who are deteriorating in hospital is often later than it should be. Several technologies could provide the basis of a solution. Recording of vital signs could be improved by both automated transmission of the measured parameters to an electronic patient record and the use of unobtrusive wearable monitors that track the patient's physiology continuously. ⋯ Software algorithms could identify such patients with greater sensitivity and specificity than the existing, paper-based track-and-trigger systems. Electronic storage of vital signs also makes intelligent alerting and remote patient surveillance possible. However, the potential of these technologies depends strongly on implementation, with poor-quality deployment likely to worsen patient care.
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The need to use front-line antibiotics wisely has never been greater. Antibiotic resistance and multi-drug resistant infection, driven by antibiotic use, remain major public health and professional concerns. ⋯ The number of new antibacterials reaching clinical practice has reduced significantly in the last 20 years, most being focused on therapy of Gram-positive infection - eg linezolid, daptomycin, telavancin and ceftaroline. Recent guidance on antibiotic stewardship in NHS trusts in England is likely to provide a backdrop to antibiotic use in hospitals in the next 5 years.
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Up to 5% of young adults diagnosed with diabetes have a monogenic aetiology, the most common of which is maturity-onset diabetes of the young (MODY). A definitive molecular diagnosis is important, as this affects treatment, prognosis and family screening. ⋯ This article aims to introduce general physicians to the characteristics of monogenic diabetes and the clinical features that can be used to diagnose patients. Recently, genomewide association studies have resulted in the identification of C-reactive protein and glycan profile as specific biomarkers for the most common MODY subtype due to HNF1A mutations, and the potential translation of these findings are discussed.
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Gastrointestinal (GI) conditions are common in women of childbearing age. They often present before pregnancy but can arise de novo during pregnancy. ⋯ In this article, we summarise the clinical features, investigation and management of common GI and liver conditions that are incidental to pregnancy, and describe the specific features of pregnancy-related disorders that are less frequently encountered by general physicians. Newer developments in areas that are increasingly encountered in obstetric medical practice, including pregnancy after bariatric procedures, are also described.