Journal of the Royal College of Physicians of London
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J R Coll Physicians Lond · May 1999
Review Practice Guideline GuidelineMaintaining good medical practice. Clinical governance and self regulation for physicians. A report of the Royal College of Physicians.
A high standard of medical practice is a prerequisite of good medical care and clinical governance is the means for ensuring that a high standard is maintained. In February of this year the College issued the following report to its Fellows and Members. The report states unequivocally the College's position on clinical governance and self-regulation and what it expects of individual physicians and their employers in implementing them. Some of the proposals have already been acted upon and are set in train; others will require additional resources and the commitment of the Department of Health and the Trusts.
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J R Coll Physicians Lond · May 1999
Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable?
(i) To determine the incidence of unexpected deaths occurring on general wards, and whether any were potentially avoidable; (ii) to assess whether the quality of care on general wards prior to admission to intensive care affected subsequent outcome. ⋯ Patients with obvious clinical indicators of acute deterioration can be overlooked or poorly managed on the ward. This may lead to potentially avoidable unexpected deaths or to a poorer eventual outcome following ICU admission. Early recognition and correction of abnormalities may result in outcome benefit, but this requires further investigation.
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Today's Royal Colleges can be traced to the guilds that arose during the 13th and 14th centuries. They fulfil similar roles: to maintain the highest standards of practice, professional integrity and self-regulation. ⋯ It considers whether these functions are still appropriate for the rapidly changing practice of medicine today. The colleges have unique strengths, but they also have weaknesses and must be prepared to counter threats to their professional function.
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J R Coll Physicians Lond · Jan 1999
Effectiveness of a 'thrombolysis nurse' in shortening delay to thrombolysis in acute myocardial infarction.
To determine whether a specialist cardiac nurse would improve delay to thrombolysis in acute myocardial infarction (MI). ⋯ A thrombolysis nurse produced a dramatic improvement in median door-to-needle and pain-to-needle times in patients presenting with definite MI. This would lead to an additional 41 lives saved at 30 months per 1,000 patients treated. With 24-hour thrombolysis nurse cover, this would potentially lead to 8 additional lives saved at 30 months at a cost of 12,300 Pounds each. There was also a striking improvement in door-to-needle times for patients presenting with a non-diagnostic first ECG who subsequently qualified for thrombolysis.