Clin Med
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The Court of Appeal judgment that Janet Tracey's human rights had been breached when a 'do not attempt cardiopulmonary resuscitation' (DNACPR) form was written about her without her knowledge has far-reaching implications for clinical practice. The 'duty to consult' extends to all patients apart from those in whom it is likely that discussion would cause 'physical or psychological harm'. ⋯ Problems with DNACPR decisions predate the Tracey case, and a coordinated alternative approach is needed: patients should be given information so that they can anticipate, initiate and participate in discussions; resuscitation decisions should be considered early in treatment, in a community setting or at predictable junctures; resuscitation should not be considered in isolation but within the context of other goals of care. Models addressing these issues have been developed.
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Effects of experimental inductions for newly qualified doctors on competence at clinical procedures.
Up to 96% of newly qualified doctors fail one or more clinical procedure tests. Their entrance into work in hospitals has been associated with significant reductions in patient safety and an increase in patient mortality. Curriculum changes offer one solution. ⋯ Experiments reported in the literature showed improvements in new doctors' competence at intravenous line insertion and taking blood after a 5-day or 2-week induction, intravenous drug administration after a 5-day induction, certifying death, prescribing and out-of-hours tasks after a 2-week induction, and lumbar puncture and spirometry after a 1-day induction. Examined performance after a 5-day induction also showed improved objective structured clinical examination (OSCE) scores on blood pressure, cannulation, venepuncture and catheterisation. There is therefore value in scheduling inductions before doctors report for their first day on the job.