Clin Med
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Nasogastric tube insertion is a common clinical procedure carried out by doctors and nurses in NHS hospitals daily. For the last 30 years, there have been reports in the medical literature of deaths and other harm resulting from misplaced nasogastric tubes, most commonly associated with feed entering the pulmonary system. In 2005 the National Patient Safety Agency in England assembled reports of 11 deaths and one incident of serious harm from wrong insertion of nasogastric tubes over a two-year period. ⋯ In the two and a half years following this alert the problem persisted with a further five deaths and six instances of serious harm due to nasogastric tube misplacement. This is a potentially preventable error but safety alerts advocating best practice do not appear to reliably reduce risk. Alternative solutions, such as standardising procedures, may be more effective.
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Over half a century ago, a Canadian judge defined a profession in a way that resonates still today, not only for lawyers and doctors, but for the current wide variety of professions and professionals. This article is a reflection on this definition. It briefly considers the historical context within which the knowledge base that characterises a profession evolved and what the various component parts of the judge's definition entail. A final consideration goes beyond the terms of the definition proposed--that of our ethical responsibility as professionals to stand up and be counted and, in the context of the disorder around us, to speak out.
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Polymyalgia rheumatica (PMR) is among the most common reasons for long-term steroid prescription with great heterogeneity in presentation, response to steroids and disease course. The British Society for Rheumatology and the British Health Professionals in Rheumatology have recently published guidelines on management of PMR. The purpose of this concise guidance is to draw attention to the full guidelines and provide a safe and specific diagnostic process with advice on management and monitoring--specifically targeted at general practitioners, general physicians and rheumatologists.