Clin Med
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This paper reports on a study that aimed to assess the inter-rater agreement of observable neurological signs in the upper and lower limbs (eg inspection, gait, cerebellar tests and coordination) and elicitable signs (eg tone, strength, reflexes and sensation). Thirty patients were examined by two neurology doctors, at least one of whom was a consultant. The doctors' findings were recorded on a standardised pro forma. ⋯ Almost perfect agreement was seen for cerebellar signs and inspection (a combination of speed of movement, muscle bulk, wasting and tremor); substantial agreement for strength, gait and coordination; moderate agreement for tone and reflexes; and only fair agreement for sensation. The inter-rater agreement is therefore better for observable neurological signs than for elicitable signs, which may be explained by the additional skill and cooperation required to elicit rather than just observe clinical signs. These findings have implications for clinical practice, particularly in telemedicine, and highlight the need for standardisation of the neurological examination.
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The health burden in most countries has changed. Although acute care is needed for trauma, acute illness and exacerbations of chronic disease, most of the burden is now long term. ⋯ The current hospital- and doctor-centric focus needs to change to one where specialists work in the community as much as in hospitals and share this different type of care with others. For potential future doctors, the scientific basis of medicine will still underpin their unique role in diagnosis and prescribing, but they will need to understand these other changes and to be selected according to attributes compatible with their future role, and then be trained and assessed accordingly.
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The clotting screen is an 'integral' part of the routine blood tests in most medical wards. It is likely that only with the increasing requests for prothrombin time and activated partial thromboplastin time are abnormal results noted. ⋯ Due to variable understanding of this complex system, many misconceptions have arisen in relation to the clinical effects expected from abnormal clotting screens. Some of these are discussed with considerations of appropriate management in those situations.
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Ambulatory emergency care (AEC) is an essential component of any acute medical unit (AMU). This statement is predicated on the clinical and financial benefits it confers. ⋯ The initial data collated demonstrates the impact the service has had locally on patient care and experience. It recommends ambulatory care as driver of better patient flow and enhanced patient experience within the AMU.