Clin Med
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Non-invasive ventilation (NIV) has become the standard of care for most patients with ventilatory failure due to an acute exacerbation of chronic obstructive pulmonary disease (COPD). In all but a small minority, even of the very sickest, there is little to be lost by at least a short trial of NIV. ⋯ There are no randomised controlled trials of NIV in patients with acute ventilatory failure due to obesity but the outcome from invasive ventilation is poor and the results of NIV encouraging. Finally, NIV may have a role during the transition from active care, aimed to extend life, to palliative care.
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The objective of this study was to describe the provision of consultant rheumatology services and the pattern of inequalities in UK rheumatology service provision, and to summarise the five-year impact of the new NHS consultant contract and the Musculoskeletal Services Framework in England and Wales. All consultants on the British Society for Rheumatology/Arthritis Research UK Consultant Workforce Register in January 2007 and January 2009 were sent questionnaires about timetable and working conditions and the personal and job-related details currently held about them on the register. ⋯ Levels of provision in 2009 were lower in Scotland (1 WTE per 113,286 population) than the rest of the UK. There are now few regional variations in rheumatology consultant provision within the UK, and the number of WTE consultants is approaching recommended levels.