Clin Med
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The majority of physicians work a weekly timetable consisting of programmed activities (PAs) defined by the consultant contract. This paper describes the implementation of an annualised contract within a gastroenterology department, which is located across two district general hospital sites within the same trust. The perceived benefits of the system include the introduction of a new out-of-hours emergency endoscopy service, more efficient backfilling of vacant endoscopy lists and greater transparency of work patterns and workload between colleagues and within the trust.
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The management of patients with hypercalcaemia should be informed by the patient's symptoms and signs, by the degree of elevation of calcium, by the underlying mechanism by which calcium has been elevated and by the disease process underlying the presentation. Regardless of diagnosis, all significantly hypercalcaemic patients should be rendered euvolaemic before any further and more specific treatment is considered. Highly symptomatic patients and those with a calcium level of > 3.5 mmol represent a medical emergency that requires inpatient treatment.
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An increasing number of people with type 1 diabetes mellitus are using insulin pump therapy, also known as continuous subcutaneous insulin infusion therapy (CSII). Most patients using pumps are safest remaining on CSII if admitted to hospital, unless incapacitated. This review provides the generalist physician with a framework to guide the management of such patients, although one should always seek specialist diabetes advice where available.
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One percent of laboratory samples are rejected as 'unsuitable for analysis’. Although this may be due to incorrect handling, a proportion are attributable to underlying pathology affecting serum, contamination or artefact. In this Lesson of the month we present two case reports. ⋯ In both cases, the laboratory comments had important diagnostic implications. Early identification of lipaemic serum from hypertriglyceridaemic pancreatitis in the first case allowed directed therapy with insulin, and hyperviscous serum from lymphoma in the second allowed directed therapy with plasma exchange and chemotherapy. Other causes of analyser artefact are tabulated to serve as a useful template for hospital doctors in considering underlying causes and practical solutions.