Clinical medicine (London, England)
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Vitamin D deficiency is a public health concern. Mediated by classical endocrine effects, vitamin D deficiency is causally linked with bone and calcium disorders. ⋯ Supported by large volumes of observational studies linking low circulating vitamin D with negative outcomes for many common disease states, there is growing interest that vitamin D may be central to the pathology and outcomes of many common diseases, including cardiovascular, cancer and autoimmune conditions. This article explores the quality of evidence linking vitamin D and various disease outcomes, and furthermore describes some of the cellular and molecular mechanisms of vitamin D action that may help explain some of the incongruity of data observed in observational versus interventional studies of vitamin D supplementation.
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The Royal College of Physicians' FallSafe care bundles constitute measures of good practice, some of which are recommended for all patients, some are additional measures for older and more vulnerable patients admitted to hospital, and there is another bundle for after an inpatient fall, to reduce the number of inpatient falls. In 2013 a dedicated healthcare assistant, trained by the falls team, started a monthly spot audit looking at preventative measures, on all inpatients on every ward of the trust. Monthly results were fed back to the ward managers, ward falls liaison nurses, doctors, therapists and pharmacy staff on each ward, to discuss at the monthly ward governance meetings. ⋯ Compliance with the measures recommended by the FallSafe care bundles has improved following regular spot audit and training. This has led to an overall reduction in the number of inpatient falls. Despite this however, in the real world of changing patient demographics, ward closures and the increasing use of ambulatory care, the number of falls/1,000 bed days has increased.
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Destructive communication is a problem within the NHS; however previous research has focused on bullying. Rude, dismissive and aggressive (RDA) communication between doctors is a more widespread problem and underinvestigated. We conducted a mixed method study combining a survey and focus groups to describe the extent of RDA communication between doctors, its context and subsequent impact. ⋯ Impact of RDA communication was described as personal, including emotional distress and substance abuse, and professional, including demotivation. RDA communication between doctors is a widespread and damaging behaviour, occurring in contexts common in healthcare. Recognition of the impact on doctors and potentially patients is key to change.
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Smoking is a major risk factor for a range of diseases, and quitting smoking provides considerable benefits to health. It therefore follows that clinical guidelines on disease management, particularly for diseases caused by smoking, should include smoking cessation. The aim of this study was to determine the extent to which this is the case. ⋯ Although the extent to which smoking and smoking cessation was mentioned in the guidelines varied between diseases, only 60% of guidelines identified recognised that smoking is a risk factor for the development of the disease and 40% recommended smoking cessation. Only 19% of guidelines provided detailed information on how to deliver smoking cessation support. Smoking cessation is not comprehensively addressed in current UK and transnational European clinical practice guidelines and recommendations.