British journal of hospital medicine
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With infection rates approaching 80% for patients staying in ICU for more than 5 days there is clearly a need for effective prophylaxis. SPEAR is a system of antimicrobial prophylaxis which extends the regimen of selective digestive tract decontamination to encompass systemic antimicrobial prophylaxis and includes oral non-absorbable antibacterial and antifungal agents with initial use of a broad-spectrum systemic antibacterial.
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The specialty of palliative medicine has developed rapidly in the last few years incorporating many aspects of care of the terminally ill. It provides a unique opportunity to work within a multidisciplinary team providing total care for a patient and his family. There is undoubtedly an increasing demand from the public for this kind of service. Palliative medicine is a challenging specialization in which a career structure is currently being developed.