British journal of hospital medicine
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Profound hypothermia, defined as a core temperature of less than 28 degrees C, is a life-threatening situation associated with high mortality. Causes of severe hypothermia are prolonged exposure to cold air, water or snow. Initial basic life support and correct decisions to further therapeutic management are crucial for the patient's outcome.
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The use of colloid solutions for fluid resuscitation in hypovolaemic patients is widespread in clinical practice. This article describes the types of colloid agents which are currently available, their physicochemical properties, and adverse effects which may follow their administration. The relative merits of colloids compared with crystalloid solutions are discussed.
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Fast-tracking in cardiac surgery evolved as the pressure on bed space in intensive therapy units (ITU) grew and clinical management improved. It relies on achieving a patient condition that allows for earlier extubation and postoperative management in alternative facilities to the ITU.
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Society places a responsibility on the medical profession for the prevention of suicide. In this article, current trends in suicide, social prevention strategies and the role and limitations of medical intervention are reviewed.
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Contracts are the glue of the new NHS, the vital tool linking the two main structures: health-care commissioning and health-care provision, carried out by GP fund holders and district health authorities (the purchasers) and the NHS trusts and others (the providers) respectively. Like all adhesives, contracts are of great benefit if used carefully, but if applied inappropriately or with an overly heavy hand they have the potential to become an obstructive mess.