Clin Med
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Iron-deficiency anaemia (IDA) is often inappropriately investigated. This study aimed to improve referrals, estimate cost implications and determine effectiveness of referral criteria for diagnosing cancer. Patients referred for investigation of anaemia were studied. ⋯ Fourteen of 112 patients with IDA had cancer versus 4/109 non-IDA (p < 0.025), overall prevalence 8.1%. Many referrals for anaemia investigation are inappropriate and a 35% reduction was achieved. The sensitivity and negative predictive value of the referral criteria for diagnosing gastrointestinal cancer were 77.8% and 96.3% respectively.
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To comply with the European Working Time Directive (EWTD), from 1 August 2009, junior doctors are required to work no more than 48 hours per week. In accordance with this, East Sussex Hospitals Trust introduced changes to working practice in August 2007. ⋯ However, there was a notable increase in episodes of sick leave among junior doctors. Implementation of the EWTD may maintain standards of patient care but may be detrimental to the welfare of doctors in training.
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Transient ischaemic attack (TIA) is the sudden onset of focal neurological dysfunction of presumed vascular origin that, by definition, resolves within 24 hours (usually much sooner). Its importance as a predictor of completed stroke has only recently been recognised. Updated guidance on the recognition and management of TIA has recently been published as part of the National Clinical Guideline for Stroke. This is a concise version of the TIA component of the full guideline that recommends an urgent response to TIA to prevent subsequent stroke.
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Intermediate care (IC) has been government policy for implementation in the U. K. for almost 10 years. It was hoped that it would help free up acute hospital resources. ⋯ Typically, outcomes are very similar to traditional hospital care and they tend to be met with high patient satisfaction. Yet there is no evidence that they reduce acute hospital use or that they are cost efficient. Maybe it is time to rethink our national strategy on this issue?