Clin Med
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Comparative Study
The impact of consultant-delivered multidisciplinary inpatient medical care on patient outcomes.
Consultant-delivered care has been shown to improve outcomes for acute medical patients. However, the ideal composition of a medical team to support consultant-delivered care is not clear and little is known about the effect of continuing consultant-delivered care until the patient is discharged. ⋯ No difference between the groups was seen for readmission rates, patient safety or mortality. In conclusion, a CD-MDT is a safe and effective model of inpatient medical care and is associated with a shorter length of hospital stay.
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Thoracic ultrasound training has become part of the respiratory medicine curriculum. Data on training, access to teaching and achievement of competency in thoracic ultrasound by respiratory specialty trainees are scarce. Using the web-based kwiksurveys, we surveyed current respiratory specialty trainees (STs) in the UK. 177 responses were recorded. ⋯ Overall, 28.8% had achieved level 1 competency but only 44.4% of trainees at ST6 and above were level 1 competent. The majority of respiratory trainees have access to thoracic ultrasound but structured training is limited, with only a small proportion of trainees attaining level 1. More structured training and mentoring is needed to enable trainees to achieve the required competencies.
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NHS ePortfolio is currently the standard assessment method used for most UK training programmes, from the Foundation Programme to core and specialty training years. This article discusses the terminology used in online assessments and gives a hands-on guide for trainees in how to successfully use ePortfolio.
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Comparative Study
Interferon gamma release assays and the NICE 2011 guidelines on the diagnosis of latent tuberculosis.
In this clinical audit, we assessed retrospectively the current practice of respiratory physicians with respect to interferon gamma (IFNγ) release assay (IGRA) testing for tuberculosis (TB), as recommended by the 2011 National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis and management of TB. All IGRAs requested by respiratory physicians over a 3-year period were identified retrospectively, and both results and clinical indications analysed. Of the total number of IGRAs carried out, 90% formed part of investigations of suspected active TB. ⋯ Of patients with chest X-rays suggestive of TB, 92.3% were treated for active TB. Of the patients under the age of 35 with reactive IGRAs, 84.6% were treated for active or latent TB and 15.4% had justifiable reasons for not receiving chemoprophylaxis. Based on the results of our audit, IGRAs are commonly being utilised for the investigation of active TB, which is contrary to current guidance.
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Diabetic retinopathy (DR) is the leading cause of visual loss in the developed world in those of working age, and its prevalence is predicted to double by 2025. The management of diabetic retinopathy has traditionally relied on screening, on laser treatment delivered by ophthalmologists, and on optimising blood glucose and blood pressure. ⋯ Antagonism of vascular endothelial growth factor offers a new therapeutic avenue that may transform the management of diabetic macular oedema. Several other therapeutic options are under investigation and development, including aminoguanidine, sorbinol, ruboxistaurin and autologous stem cell transfusion.