Clinical medicine (London, England)
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Observational Study
'The time it takes…' How doctors spend their time admitting a patient during the acute medical take.
Patient safety depends on adequate staffing but the number of doctors required for safe staffing for medical emergencies is not known. We measured the duration of the admission process for patients seen by medical teams in emergency departments (EDs) and acute medical units. ⋯ The duration of post-take ward rounds also showed significant variability. Our data can be used to model staffing patterns if combined with information about admission numbers and local set up.
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Diabetic ketoacidosis (DKA) is a common medical emergency. The pathophysiology of DKA in patients with advanced chronic kidney disease differs significantly from patients with preserved renal function. We describe a patient with pre-dialysis renal failure who presented with DKA. This case highlights the importance of tailoring the established management guidelines appropriately.
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Trainees in higher specialty training programmes may have the option to take time out of their training programme to enhance or broaden their skills and perhaps develop a subspecialty interest. Traditionally, out of programme experience has been mostly taken by clinical academic trainees in order to undertake a higher research degree. However, there are a growing number of other ways to usefully spend time out of programme. This article is intended to highlight the range of opportunities and explain the modern processes for obtaining permissions to enable trainees to make good choices for themselves.
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Diagnostic errors are responsible for a significant number of adverse events. Logical reasoning and good decision-making skills are key factors in reducing such errors, but little emphasis has traditionally been placed on how these thought processes occur, and how errors could be minimised. In this article, we explore key cognitive ideas that underpin clinical decision making and suggest that by employing some simple strategies, physicians might be better able to understand how they make decisions and how the process might be optimised.