Clin Med
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The depolarising neuromuscular blocking agent suxamethonium chloride, frequently used during endotracheal intubation, is contraindicated in patients with chronic denervation in whom it can cause a life-threatening hyperkalaemic reaction, thought to be mediated through upregulation of nicotinic alpha7 acetylcholine receptors. An underlying neuromuscular disorder should be considered in all patients with acute respiratory insufficiency, and an alternative neuromuscular blocking drug must be used if there is any possibility of widespread denervation.
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Although telephone consulting is increasingly used by clinicians seeking to balance rising caseloads, heightened patient expectation and the desire to ensure continued improvements in the quality, convenience and accessibility of the care they provide, its use to provide care to renal transplant recipients has not previously been described. Climate change is a major global public health threat. ⋯ This article reports the use of telephone consultation clinics to provide follow-up to renal transplant recipients over a three-year period. The benefits of this service to patients, providers and the environment are outlined, the existing literature regarding the provision of virtual care to patients with kidney disease is reviewed, and the possibilities of more widespread adoption are discussed.
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Following successful pilots in 2006, knowledge-based assessments for those engaged in specialty training have been developed and implemented in 11 medical specialties, by the Federation of Royal Colleges of Physicians in partnership with the specialist societies. Over 400 physicians have been involved in a project that has required recruitment and training of up to 25 question writers in each discipline, and the constitution of examining boards and standard setting advisory groups in each specialty. ⋯ A total of 786 candidates sat the examination in the UK, 162 in overseas centres. Pass rates among UK trainees have generally exceeded 80%, with reliability coefficients well in excess of 0.8.
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As a consequence of change in medical, educational and regulatory practice, MRCP(UK) successfully modified the international PACES examination in 2009. This brief paper explains the rationale for change and summarises the development and implementation process.