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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Case Reports
The ill, jaundiced patient: a triple whammy and the importance of waiting for all results.
There are many causes of raised liver function tests in HIV infection. This lesson discusses a case where autoimmune hepatitis, acute hepatitis B and acute toxoplasmosis were diagnosed in a lady presenting with abdominal pain and jaundice. Oral steroids for autoimmune hepatitis may have worsened the clinical picture as her hepatitis serology was not available at the time. This lesson highlights the importance of waiting for all serology results to return in an ill jaundiced patient before deciding on active management and treatment