Clin Med
-
This paper outlines the development and evaluation of the utility of workplace-based assessments in higher medical training: case-based discussion (CbD); the acute care assessment tool (ACAT); audit assessment; teaching observation and patient survey (PS). The study population included trainees in higher medical training (ST3+) from physician specialties in the U. K. ⋯ For adequate reliability (co-efficient 0.7) a total of 12 CbDs; three ACATs and 16 PS raters are required. There was evidence for the validity and positive educational impact of all the tools. There were difficulties with the feasibility of the PS.
-
Case Reports
The ill, jaundiced patient: a triple whammy and the importance of waiting for all results.
There are many causes of raised liver function tests in HIV infection. This lesson discusses a case where autoimmune hepatitis, acute hepatitis B and acute toxoplasmosis were diagnosed in a lady presenting with abdominal pain and jaundice. Oral steroids for autoimmune hepatitis may have worsened the clinical picture as her hepatitis serology was not available at the time. This lesson highlights the importance of waiting for all serology results to return in an ill jaundiced patient before deciding on active management and treatment
-
Comparative Study
Initial experience with a rapid access blackouts triage clinic.
Transient loss of consciousness (T-LOC), or blackout, is common in acute medicine. Clinical skills are not done well, with at least 74,000 patients misdiagnosed and mistreated for epilepsy in England alone. The aim of this study was to provide a rapid, structured assessment and an electrocardiogram (ECG) for patients with blackouts, aiming to identify high risk, reduce misdiagnoses, reduce hospital admission rates for low-risk patients, diagnose and treat where appropriate, and also provide onward specialist referral. ⋯ The U. K. has low rates of pacing compared to Western Europe, which RABTCs might help correct. The RABTC sits between first responders and specialist referral, providing clinical assessment and ECG in all cases, and referral where appropriate.