Clin Med
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It is widely assumed by the general public that if assisted suicide (AS) or euthanasia (VE) were legalised doctors must be essentially involved in the whole process including prescribing the medication and (in euthanasia) administering it. This paper explores some reasons for this assumption and argues that it flatly contradicts what it means to be a doctor. The paper is thus not mainly concerned with the ethics of AS/VE but rather with the concept of a doctor that has evolved since the time of Hippocrates to current professional guidance reflected in healthcare law. The paper argues that the most common recent argument for AS/VE--that patients have a right to control when and how they die--in fact points to the involvement not of doctors but of legal agencies as decision makers plus technicians as agents.
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The development of evidence-based guidelines requires scrupulous attention to the method of critical appraisal. Many critical appraisal systems give 'gold standard' status to randomised controlled trials (RCTs) due to their ability to limit bias. ⋯ A review of the Scottish Intercollegiate Guidelines Network, the Grading of Recommendations Assessment, Development and Evaluation, the Graphic Appraisal Tool for Epidemiology and the National Service Framework for Long Term Conditions grading systems was therefore undertaken. A matrix was developed suggesting the optimum grading system for the type of guideline being developed or question being addressed by a specialist society.
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Quality of care in intensive care and surgery has benefited from establishing comparative standards. At present there is no accepted tool to compare outcomes for emergency admissions in internal medicine. ⋯ Three parameters with poor reproducibility were identified. The SCS has several potential applications: identification of patients with low risk of death suitable for early hospital discharge; early identification of patients with a high risk of death, who will require care in critical care areas (or specialist palliative care); and benchmarking of acute medical departments internationally in a similar way to how APACHE II scoring has been used in critical care units worldwide.
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The European Working Time Directive (EWTD) has resulted in large changes in the working patterns of junior doctors in the U. K. All consultant physicians in England and Wales were invited to anonymously submit data on their teams for 11 am and 11 pm on 5 November 2009. ⋯ Trainees were available for training 66-80% of the time. These findings have significant implications for patient safety and quality of medical training in the U. K.