Clin Med
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Numbers of National Clinical Assessment Service referrals concerning practitioners' performance are much higher for the over-50s, especially in GPs. In 20% of cases there are concerns with diagnosis that are unlikely to be recognised by revalidation. ⋯ We need to assess pratictioners' competencies in diagnosis throughout their careers. Plans to extend working life may require changes to the clinical responsibilities of older doctors.
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Fluid overload is a common manifestation of decompensated chronic heart failure. This paper reports on a pilot study that investigated whether intravenous (i.v.) furosemide administered on a cardiology day ward for three successive days was effective in improving the symptoms of patients with fluid overload and chronic heart failure. The results showed that 94.1% of patients reported an improvement in their breathlessness, with a marked weight loss in 88.2% of patients. ⋯ Hospital admission was avoided in 94.1% of cases. The study concluded that i.v. diuretic treatment given in a hospital day-care setting is safe and effective, and that it reduces the need for hospital admissions. As a consequence, this reduces the associated financial costs of hospitalisation.