Clin Med
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Multicenter Study Comparative Study
Getting the basics right: delays in phlebotomy and intravenous cannulation: a survey of foundation year 1 doctors.
Junior doctors frequently experience delays in routine ward-based procedures. There is little published data on this subject, but it is clear that such delays can have implications in terms of costs, efficiency, length of patient stay, team working and patient safety and experience. We formulated an anonymous online survey to quantify the experiences of foundation year 1 (FY1) doctors with respect to phlebotomy services and intravenous (IV) cannulation. ⋯ For IV cannulation, 21% of doctors reported equipment availability as 'very good', but only 3% said that they were able to find all of the pieces of equipment they needed close to each other ('essentially in the same place'). Similar results were obtained for phlebotomy. Nevertheless, there appears to be significant room for improvement and we offer recommendations to address delays.
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Case Reports
Overfeeding and overhydration in elderly medical patients: lessons from the Liverpool Care Pathway.
This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. ⋯ Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.
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Takotsubu cardiomyopathy (TC) describes transient left ventricular apical ballooning due to akinetic myocardium. It mimics acute coronary syndrome, with similar electrocardiogram changes and raised troponin, but visible coronary artery stenosis is missing. Patients usually recall a preceding stressful event and post-menopausal women are at greatest risk. ⋯ Treatment is supportive and complications include arrhythmias, cardiac rupture, thrombus formation and congestive cardiac failure. The prognosis is favourable and by definition cardiac function returns to pre-morbid levels. Mortality is rare (1–2%).
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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.