Clin Med
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Bed availability remains the main operational focus for managers and clinicians on a day-to-day basis within the NHS. There is now published research that establishes a lack of bed stock is too simplistic an explanation of the situation. ⋯ So far most of what little work has been done has focused on the front end of the process, to 'buffer' unplanned admissions through the use of short-stay facilities, such as medical assessment units, as a short-term solution. This paper reviews the evidence for the hypothesis that bed availability problems can be solved by actions other than the addition of more beds to the system.
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Review
Management of acute exacerbations of chronic obstructive pulmonary disease: the first 24 hours.
Successful outcome is more likely with early treatment and lesser degrees of acidosis. While aiming for maximum treatment for the first 24 hours, some patients improve so rapidly that they can discontinue after a shorter time. Most patients need a full face mask and oxygen, and nebulised bronchodilators can be incorporated. ⋯ Patients can often be quickly weaned on to NIV and returned to the ward after an initial period of invasive support and secretion management. Initial assessment and the past history should identify those markedly disabled patients with recurrent admissions who are likely to be entering the terminal stages of their illness in whom intubation is inappropriate. Here, NIV may be the ceiling of treatment, providing useful symptom palliation while waiting for treatment to
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The trainee-led clinicopathological conference: an innovative method for educating medical trainees.
Adult learning theory states that adults learn by setting their own goals and making their learning applicable to the real world. Postgraduate training in medicine is now regulated by the 'gold guide', which emphasises the importance of trainee-led education. A new method of delivering education that allows trainees to develop generic skills as well as knowledge, the trainee-led clinicopathological conference, will be discussed. This method embraces the principles of adult learning theory and has been well received by trainees.