Clin Med
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It is a concern that increasing pressure to diagnose, treat and discharge patients rapidly is leading to unacceptably high readmission rates. Readmissions were studied over a two-month period. Patients were identified through the hospital coding system, and electronic discharge summaries provided details of each admission. ⋯ Readmission is more likely in older patients with complex care needs. Rapid throughput of patients is not associated with readmission. The majority of readmissions can potentially be avoided with judicious medical care.
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Breathlessness is a common symptom in respiratory, cardiovascular and malignant disease. It reduces exercise tolerance and mobility, and is an important determinant of quality of life. The multifactorial nature of the symptom often presents difficulties in understanding why individual patients are breathless, and how breathlessness should best be palliated, especially in advanced disease. ⋯ Mismatch between efferent neural respiratory drive and afferent feedback, reflecting the degree of neuromechanical dissociation, is also important. This paper describes mechanisms by which ventilatory load, capacity and drive may be affected by disease, and how these can be measured physiologically. The schema presented also provides a framework for understanding the mechanisms by which interventions that relieve breathlessness may have their effect.
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The Foundation Programme curriculum describes 'generic skills' for doctors, which illustrate many of the attributes of medical professionalism. Educators from the Dorset acute trusts have worked with faculty members of the School of Health and Social Care at Bournemouth University to create a course in professionalism for Foundation Programme Year 2 doctors. The course, held away from the hospital setting but facilitated by consultants as well as university staff, has six themes taught on different days: professionalism and judgement, relationship with society, accountability, teamworking and leadership, relationship with patients, and excellence and continuous improvement. The emphasis is on group discussion between the participants, and feedback to the whole group, rather than didactic lecture-based teaching, with the aim of encouraging Foundation Programme doctors to become more reflective in their practice, and to discover their own answers to their queries.