Journal of the Royal College of Physicians of London
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J R Coll Physicians Lond · Mar 1997
Assessment of cardiopulmonary resuscitation in the membership examination of the Royal College of Physicians.
The poor performance of doctors in cardiopulmonary resuscitation has been described in several studies. The problem has been addressed in the last few years by simplifying treatment algorithms, establishing standards of competence, and creating a training framework. Resuscitation skills are also assessed during formal examinations such as those for the membership of the Royal College of Physicians (MRCP(UK)). ⋯ With the correct preparation, there was no difficulty in carrying out detailed assessment of basic life support, defibrillation and advanced life support. This assessment was carried out separately from that of the examiners and did not interfere with the running of the short cases. The resuscitation skills of this small sample of an important group of doctors in training grades were unsatisfactory, and we suggest that more should be done to raise standards.
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J R Coll Physicians Lond · Jan 1997
'Brain attack'--aneurysmal subarachnoid haemorrhage: death due to delayed diagnosis.
The objectives of this study were to determine how quickly patients who have an aneurysmal subarachnoid haemorrhage are diagnosed and referred to a regional neurosurgical unit for assessment and management. We examined whether delayed diagnosis resulted in poorer management outcome and how such delays could and should be avoided. An in-depth analysis of pre-hospital and hospital management of 180 consecutive patients with an aneurysmal subarachnoid haemorrhage was carried out at the Wessex Neurological Centre, a regional neuro-surgical unit with a catchment population of 2.8 million people. ⋯ In this group, failure to recognise this condition resulted in 45 patients (65%) suffering a second or third haemorrhage before being diagnosed. As a direct consequence of this delay significantly more patients died or were severely disabled than those whose haemorrhage was diagnosed without delay (chi 2 = 8.27, p < 0.005). Delays in diagnosis and transfer to a neurosurgical unit are largely avoidable.
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Competence in temporary transvenous cardiac pacing is an important part of general professional training. A questionnaire survey from district general hospitals in the North West Region suggests junior medical staff have little experience in this procedure and require a formal teaching programme.
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J R Coll Physicians Lond · Sep 1996
Historical ArticleDeprivation and health. Chadwick Lecture 1996.
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Assessment of general practitioner (GP) new referrals to a neurology department in terms of satisfaction for patient and doctor. ⋯ Patients and GPs usually found the referral helpful. Seeing patients more briefly is inappropriate since almost a third already felt consultation time to be short. Although some referrals may have been inappropriate, the dominant deficiency in the service was the time they had to wait after the referral. To satisfy local need, it is estimated that twice the present number of consultant neurologists would be required.