Clin Med
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There is little evidence to support tube feeding in advanced dementia although it is still frequently used in acute hospital settings. Patients present with complex problems and are often unable to make decisions about their healthcare needs. ⋯ This paper guides decision making in the management of patients with dementia and dysphagia in the acute hospital setting. A structured approach to information gathering, assessment and management is outlined with practical application of recent published guidelines and research evidence, which ensures appropriate individualised care.
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Multicenter Study Comparative Study
Acute medical care. The right person, in the right setting--first time: how does practice match the report recommendations?
An acute medicine Royal College of Physicians report makes key recommendations. This study reviews organisational issues and consultant working patterns against these recommendations. Thirty-nine trusts in England and Wales were asked to participate in an online survey, which 27 completed. ⋯ Ten trusts cancelled other clinical duties for consultants responsible for acute take. The pilot shows evidence of good practice in leadership and operational policies. Further work to standardise and improve acute care is needed including a more consistent twice daily consultant review.
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Endoscopic ultrasound (EUS) is an increasingly available diagnostic and therapeutic tool used within the U. K. it has wide applications both in the gastrointestinal tract and mediastinum with its current main uses being in the staging of luminal malignancies and assessment of pancreatic and subepithelial lesions. The emergence of linear EUS has opened up new therapeutic avenues with fine needle aspiration, trucut biopsies, coeliac plexus blocks and transmural pseudocyst drainage all now possible. Future developments include localised brachytherapy/chemotherapy and alcohol ablation of unresectable pancreatic malignancies and EUS-guided endoscopic surgery.