Hospital medicine (London, England : 1998)
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The methods of monitoring the injured brain in intensive care have relied mainly on intermittent measurement. There is now increasing clinical interest in newer continuous forms of bedside monitoring that can help direct therapy earlier and more precisely. This article reviews continuous methods of monitoring cerebral perfusion, oxygenation, brain chemistry and function.
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Clinical governance represents a culture change in the NHS, making managers of health care institutions responsible for clinical standards as well as the financial bottom line. Doctors and managers will need to be educated to play their full part in this new culture.
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Morbidly obese patients are prone to many clinical conditions that can effect anaesthesia. Of major concern to the anaesthetist are difficulties with airway management and abnormalities of cardiorespiratory function. Safe anaesthesia requires an appreciation of potential problems and a thorough understanding of the pathophysiological changes that accompany morbid obesity.