Clin Med
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Prescriptions for intravenous (i.v.) fluids in hospitals may not be closely adhered to. This study prospectively examined whether prescribed i.v. fluids are administered at the correct rate. During a four-week period, the i.v. infusion rates in patients requiring continuous i.v. fluids and cared for by a single medical team in a district hospital were studied. ⋯ Marked inaccuracies in i.v. fluid infusion rates are common, and do not seem to be perceived by staff as important. Metered pumps improve accuracy. Increased awareness of such errors, and the routine use of metered pumps should help improve the accuracy of i.v. fluid infusion rates.
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Revalidation will have two core components: relicensure and specialist recertification. All doctors wishing to practise in the UK will require a licence issued by the General Medical Council and those on the specialist register will also be required to demonstrate that they meet the standards that apply to their medical specialty. ⋯ A blueprint might be used to ensure that relicensure and specialist recertification sample different domains of clinical practice during the five-year cycle, but time and money will be required to develop standards that are valid, reliable and assessable, as well as to pilot and implement the specialty-specific tools required for assessing such standards. The Royal College of Physicians and the medical specialties must engage with this process so that specialist recertification is acceptable and achievable.
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This report describes the case of an elderly physician who endured a slowly progressive, ambulatory illness, which was erroneously diagnosed as Parkinson's disease. After ten years of progressive illness the correct diagnosis of normal pressure hydrocephalus (NPH) was finally made, revealing itself, by accident, through incontinence and mild dementia. ⋯ Although the patient had been virtually restored to normal, a series of complications typical of ventriculosystemic shunting (VSS) occurred, including significant hearing loss and subdural haematoma (SDH). The patient feels, however, that his clinical improvement far outweighs the complications and that every patient with NPH should have the opportunity to decide whether or not to have a VSS.
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Occupational exposure to bloodborne pathogens remains an important and largely preventable issue in hospital practice. This article argues that formal training can increase use of best practice phlebotomy. A survey of at-risk healthcare workers at a central London hospital was conducted to identify factors associated with use of an evacuated blood collection system (BD Vacutainer and gloves while taking blood. ⋯ The only factor independently associated with glove use was operator experience. There is considerable room for improvement in phlebotomy technique, particularly among junior doctors. The Modernising Medical Careers initiative provides a unique opportunity to implement this.