Clin Med
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This paper describes the implementation of an interprofessional patient record (IPPR) at Sheffield Teaching Hospitals NHS Foundation Trust (STHFT). The IPPR was a two-year project, commencing in May 2008, aimed at creating a single IPPR to which all staff contribute. ⋯ The staff survey and clinical audit data suggest that the IPPR was successfully implemented with many of the perceived benefits realised. The keys to success of this major change project were: time spent engaging clinical staff, board level support, the appointment of a dedicated project team and the involvement and support of many staff involved in patient records throughout STHFT.
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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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Acute PE is a cardiovascular emergency and early risk stratification is important in the management of these patients. Pre-test clinical prediction models together with D-dimer assays help select those who require imaging. Each hospital should develop a strategy for investigating patients with suspected PE depending on local expertise, resources and the patient population.