Clin Med
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The New Zealand Health Service had to start adapting to significant restrictions in junior medical staff's hours of work in the mid-1980s. Some consequences of this presage those that will occur in the UK and Europe with the implementation of the European Working Time Directive (EWTD). These naturally include continuity of patient care, changing responsibility and hours of senior medical and administrative staff, some aspects of medical professionalism and training issues. Life does, however, go on.
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Levels of staffing and access to diagnostics at weekends are recognised to be significantly lower than on weekdays. It is unclear if subsequent inpatient mortality and readmission rates for acute medical admissions are increased for weekend admissions compared to those on a weekday. ⋯ Weekend admission was not associated with significantly higher in-hospital mortality, readmission rates or increased length of stay compared to the weekday equivalent for any of the six conditions. The implementation of an acute medical admissions unit in the Royal Infirmary of Edinburgh, with consistent staffing levels and 24-hour access to diagnostics for the early phase of critical illness, may have helped address the discrepancy in care suggested by previous studies.
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The optimal management of acute ventilatory failure lies in a multidisciplinary approach focusing on doing simple things correctly, close liaison between healthcare professionals and adequate communication with patients and carers. The use of NIV support is increasing in a variety of conditions, both inside and outside the ICU.
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Medicine bridges the gap between science and society. Indeed, the application of scientific knowledge to human health is a crucial aspect of clinical practice. Doctors are one important agent through which that scientific understanding is expressed. ⋯ Medical professionalism has roots in almost every aspect of modern healthcare. This Working Party could not hope to solve all the issues and conflicts surrounding professionalism in practice today. But our collective and abiding wish is to put medical professionalism back onto the political map of health in the UK.
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Mental capacity is required for an adult to make autonomous treatment choices. This review highlights recent legal and clinical developments in the field. The recent English Mental Capacity Act 2005 is described and compared with mental health legislation. ⋯ Such research indicates firstly that capacity can reliably be assessed; secondly, that among general hospital inpatients, approximately one-third may lack capacity; and thirdly, that mental incapacity in this setting is mainly driven by cognitive impairment caused by delirium or dementia. This is contrasted with psychiatric inpatients, where the problem is no more frequent, but mainly relates to psychotic illness. The article finishes with some general guidance as to how to assess mental capacity in the general hospital.