Clinical medicine (London, England)
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Oxygen is the most commonly used drug in the acute hospital setting. Oxygen can be lifesaving but there is increasing evidence that it can cause harm if it is not given correctly. Prescription of oxygen, according to target saturations, has been advocated since 2008 but compliance remains at low levels. ⋯ Data was collected for oxygen prescription and titration rates for 270 patients during the project period. The wristbands showed an improvement in prescription and titration of oxygen in two out of three sites. The results support a wider controlled study of colour-coded wristbands to improve oxygen safety in secondary care.
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Observational Study
'The time it takes…' How doctors spend their time admitting a patient during the acute medical take.
Patient safety depends on adequate staffing but the number of doctors required for safe staffing for medical emergencies is not known. We measured the duration of the admission process for patients seen by medical teams in emergency departments (EDs) and acute medical units. ⋯ The duration of post-take ward rounds also showed significant variability. Our data can be used to model staffing patterns if combined with information about admission numbers and local set up.
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We present the case of a 23-year-old Turkish man who developed extensive deep venous thrombosis as a first presentation of Behçet's disease. We describe the work-up of his condition and discuss the potential for Behçet's disease to cause deep venous thrombosis as a presenting finding.
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Historical Article
Changes to postgraduate medical education in the 21st century.
Medicine is a constantly evolving profession, especially with the advent of rapid advances in the scientific base that underpins this vocation. In order to ensure that training in medicine is contemporary with the continuous evolution of the profession, there has been a multitude of changes to postgraduate medical education, particularly in the UK. This article aims to provide an overview of relevant key changes to postgraduate medical education in the UK during the 21st century, including changes to the structure, governance and commissioning of medical education, effects of European Working Time Directive on training, recent recommendations in the Future Hospital Commission report and Shape of training report, and recent requirements for accreditation of medical education trainers. Many of these recommendations will require complex discussions often at organisational levels, hopefully with some realistic and pragmatic solutions for implementation.
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When a patient who suffers from a serious underlying disease with an ever-present potential for recurrence or progression deteriorates, other alternative diagnoses (even treatable ones) are frequently not considered. However, these patients are often immunosuppressed, which makes them susceptible to reactivation of latent viral or tuberculosis infections. Three brief cases are presented to stress the importance of looking for unsuspected, treatable herpes virus infections in these settings and the relevant cognitive aspects of misdiagnosis are discussed.