Clin Med
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Postgraduate medical training presents many instances in which a junior doctor must decide whether it is appropriate to proceed without the advice, supervision or practical assistance of a senior. These decisions, vital to the development of any doctor, are commonly made in the context of providing medical treatment to acutely unwell patients or undertaking practical procedures. ⋯ The relevance of each of these factors is explored in the context of two scenarios. In this way a simple framework to assist junior doctors in considering the risks and benefits of their intended actions is presented.
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ABSTRACT - The scale of pain intensity (SPIN)-screen is a simple visual tool for the screening and measurement of pain intensity, which is designed to be accessible by patients with cognitive and communication problems. It was applied prospectively in a consecutive cohort of 79 patients admitted to a tertiary specialist neurorehabilitation unit, of which 86% had significant cognitive/communicative disabilities. In all, 71 patients (90%) responded to the SPIN. ⋯ Repeat testing after 24 hours provided preliminary evidence for the stability and responsiveness of the SPIN-screen, but these require further evaluation. Of those who expressed a preference for one tool over the other, 70% preferred the SPIN. The study provides support for application of the SPIN-screen as a routine screening tool in this group of patients.