Clin Med
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Review
Content validity of a clinical problem solving test for use in recruitment to the acute specialties.
Clinical problem solving tests (CPSTs) have been shown to be reliable and valid for recruitment to general practice (GP) training programmes. This article presents the results from a Department of Health-funded pilot into the use of a CPST designed for recruitment to the acute specialties (AS). The pilot paper consisted of 99 items from the validated GP question bank and 40 new items aimed specifically at topics of relevance to AS training. ⋯ The overall test and the GP section showed high internal reliability, whereas the AS pilot section performed less well. A detailed item analysis revealed that the AS pilot items were, on average, more difficult and of poorer quality than the GP items. Important issues that need to be addressed in the early development phase of a test used for high stakes selection to specialty training programmes are discussed.
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Comparative Study
Initial experience with a rapid access blackouts triage clinic.
Transient loss of consciousness (T-LOC), or blackout, is common in acute medicine. Clinical skills are not done well, with at least 74,000 patients misdiagnosed and mistreated for epilepsy in England alone. The aim of this study was to provide a rapid, structured assessment and an electrocardiogram (ECG) for patients with blackouts, aiming to identify high risk, reduce misdiagnoses, reduce hospital admission rates for low-risk patients, diagnose and treat where appropriate, and also provide onward specialist referral. ⋯ The U. K. has low rates of pacing compared to Western Europe, which RABTCs might help correct. The RABTC sits between first responders and specialist referral, providing clinical assessment and ECG in all cases, and referral where appropriate.
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Comparative Study
What reductions in dependency costs result from treatment in an inpatient neurological rehabilitation unit for people with stroke?
This paper examines the reductions in care costs that result from inpatient multidisciplinary rehabilitation for younger people with acquired brain injury. Thirty-five consecutive patients admitted following a stroke over one year were recruited to this observational study. Physical ability, dependency and potential community care costs were measured on admission and discharge. ⋯ The median time to repay rehabilitation costs was 21 weeks. Savings occurred in those with moderate and severe disability and they have the potential to continue to accrue for over 12 years. Similar results will probably be found for rehabilitation in other forms of acquired brain injury.