Clin Med
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Prolonged diagnostic dilemma and poor clinical outcome in the absence of early HIV testing.
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Non-invasive ventilation (NIV) in the management of acute type 2 respiratory failure in patients with chronic obstructive pulmonary disease (COPD) represents one of the major technical advances in respiratory care over the last decade. This document updates the 2002 British Thoracic Society guidance and provides a specific focus on the use of NIV in COPD patients with acute type 2 respiratory failure. While there are a variety of ventilator units available most centres now use bi-level positive airways pressure units and this guideline refers specifically to this form of ventilatory support although many of the principles encompassed are applicable to other forms of NIV. The guideline has been produced for the clinician caring for COPD patients in the emergency and ward areas of acute hospitals.
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Modernising Medical Careers (MMC) asks trainees to commit to their specialty sooner than ever before. There has been a great deal of good-quality research on the career intentions of doctors in training. It is time to review this data with MMC's changes in mind and reflect on how earlier enforced choice may affect trainees. ⋯ Those in this group who fail to be selected will need focused career support. Doctors who commit late are more likely to be affected by quality of life and flexibility. The present 'one size fits all' system does not reflect the natural history of present career selection and commitment to specialty.